Basic Information
| Provider Information | |||||||||
| NPI: | 1528170685 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLANKENBURG | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | LEANNE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7464 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941207464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152063103 | ||||||||
| FaxNumber: | 4152063872 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 POTRERO AVENUE | ||||||||
| Address2: | RM 6D37 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941103518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152064838 | ||||||||
| FaxNumber: | 4152063686 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A83218 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 00A832180 | 05 | CA | MEDICAID |