Provider Demographics
NPI:1598981110
Name:ANTHONY BLEDIN M.D. INC
Entity type:Organization
Organization Name:ANTHONY BLEDIN M.D. INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BLEDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-988-1111
Mailing Address - Street 1:1851 HOLSER WALK
Mailing Address - Street 2:SUITE 220
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2626
Mailing Address - Country:US
Mailing Address - Phone:805-988-1111
Mailing Address - Fax:805-988-0254
Practice Address - Street 1:6325 TOPANGA CANYON BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2006
Practice Address - Country:US
Practice Address - Phone:818-703-0072
Practice Address - Fax:818-703-7934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42124C291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C421240Medicaid
CA=========OtherEIN
CAWC42124CMedicare ID - Type Unspecified