Provider Demographics
NPI:1487786133
Name:NATALIE BLANCO MIRSKY
Entity type:Organization
Organization Name:NATALIE BLANCO MIRSKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER MANAGING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:BLANCO
Authorized Official - Last Name:MIRSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-270-7549
Mailing Address - Street 1:1831 WILSHIRE BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5779
Mailing Address - Country:US
Mailing Address - Phone:310-453-1221
Mailing Address - Fax:310-829-5319
Practice Address - Street 1:1831 WILSHIRE BLVD STE E
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5779
Practice Address - Country:US
Practice Address - Phone:310-453-1221
Practice Address - Fax:310-829-5319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7458842OtherAETNA
CAW19629Medicare ID - Type Unspecified