Blackmun, Marilyn
Blackmun, Marilyn is an individual health care provider with primary practice located at 2209 San Gorgonio Rd , La Canada CA 91011-1352. She recently has only one registered license in Dental Providers / Dental Hygienist, which is considered as her primary health care specialty. Blackmun, Marilyn can be contacted via phone (818) 957-1589.Contact Information
Primary practice address
2209 San Gorgonio Rd
La Canada CA 91011-1352
Phone: (818) 957-1589
Fax: (818) 957-1589
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dental Hygienist | 124Q00000X | HAP11 | California |
Profile Details
| NPI number | 1790909349 |
|---|---|
| LBN Legal business name | Blackmun, Marilyn |
| Credentials | PDHAP |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 13th, 2007 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1790909349 | NPPES |
| California | MEDICAID | 28993701 | |
| California | Other | 133068 |
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