Provider Demographics
NPI:1396066619
Name:BLAU, JONATHAN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MICHAEL
Last Name:BLAU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:16311 VENTURA BLVD STE 1150
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4386
Mailing Address - Country:US
Mailing Address - Phone:818-477-0787
Mailing Address - Fax:818-477-0677
Practice Address - Street 1:16311 VENTURA BLVD STE 1150
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4386
Practice Address - Country:US
Practice Address - Phone:818-477-0787
Practice Address - Fax:818-477-0677
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2019-06-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA141061207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery