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ISC SAN PEDRO BLASSER CLINIC NPI 1821130113


NPI Information

NPI: 1821130113
Provider Name: ISC SAN PEDRO BLASSER CLINIC
Classification: Clinic/Center - 261QM1100X
Entity Type: Organization

Specialization: Military/U.S. Coast Guard Outpatient

Address:
1001 S SEASIDE AVE
SAN PEDRO, CA
ZIP 90731
Phone: (310) 732-7500
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ISC SAN PEDRO BLASSER CLINIC is a military/u.s. coast guard outpatient clinic center in San Pedro, CA. The provider is the Defense Health Program or U.S. Coast Guard funded fixed facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A fixed facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the fixed facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. ISC SAN PEDRO BLASSER CLINIC NPI is 1821130113. The provider is registered as an organization entity type.

The provider's business location address is:

1001 S SEASIDE AVE
SAN PEDRO, CA
ZIP 90731-333
Phone: (310) 732-7500
Fax: (310) 732-7519

The provider's authorized official is Marvin Antonio Pena .
The authorized official title is Clinic Supervisor and has the following contact phone number (310) 732-7500.

The enumeration date for this NPI number is 2/13/2007 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM1100XClinic/CenterMilitary/U.S. Coast Guard OutpatientYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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