1225155690 NPI number — MR. JASON D BLANTZ NP, MSN

Table of content: MR. JASON D BLANTZ NP, MSN (NPI 1225155690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225155690 NPI number — MR. JASON D BLANTZ NP, MSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLANTZ
Provider First Name:
JASON
Provider Middle Name:
D
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
NP, MSN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225155690
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
234 EDDY ST
Provider Second Line Business Mailing Address:
HOUSING AND URBAN HEALTH CLINIC
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94102-2716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-353-5045
Provider Business Mailing Address Fax Number:
415-292-5048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
234 EDDY ST
Provider Second Line Business Practice Location Address:
HOUSING AND URBAN HEALTH CLINIC
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94102-2716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-353-5045
Provider Business Practice Location Address Fax Number:
415-292-5048
Provider Enumeration Date:
03/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WP2201X , with the licence number:  RN568106 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363LA2200X , with the licence number: NPF13458 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 073908 . This is a "SFGH INTERNAL USE ONLY-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".