1932133600 NPI number — DR. WEISHING CYNTHIA BLAYLOCK OD

Table of content: DR. WEISHING CYNTHIA BLAYLOCK OD (NPI 1932133600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932133600 NPI number — DR. WEISHING CYNTHIA BLAYLOCK OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLAYLOCK
Provider First Name:
WEISHING
Provider Middle Name:
CYNTHIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHAO
Provider Other First Name:
WEISHING
Provider Other Middle Name:
CYNTHIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932133600
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5815 BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94618-1524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-985-6420
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1955 MONUMENT BLVD
Provider Second Line Business Practice Location Address:
SUITE 4-A
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94520-3873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-326-0120
Provider Business Practice Location Address Fax Number:
925-326-3120
Provider Enumeration Date:
07/10/2006

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: 152W00000X , with the licence number:  18003304A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 14513 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200529580 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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