Provider Demographics
NPI:1154399954
Name:BLANSCET, LAURIE (DO)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:BLANSCET
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29995 TECHNOLOGY DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2633
Mailing Address - Country:US
Mailing Address - Phone:951-461-3021
Mailing Address - Fax:951-461-8898
Practice Address - Street 1:29995 TECHNOLOGY DR STE 201
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2633
Practice Address - Country:US
Practice Address - Phone:951-461-3021
Practice Address - Fax:951-461-8898
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7007207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00184721OtherMEDICARE RAILROAD
CA1518026848OtherMEDICARE ORGANIZATIONAL NPI
CA020A70070OtherBLUE SHILED
CAP00184721OtherMEDICARE RAILROAD
CA020A70070Medicare PIN
CA1518026848OtherMEDICARE ORGANIZATIONAL NPI