Provider Demographics
NPI:1053375568
Name:BLASBAND, DAVID E (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:BLASBAND
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 FIGUEROA ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-3048
Mailing Address - Country:US
Mailing Address - Phone:831-233-8219
Mailing Address - Fax:831-656-0330
Practice Address - Street 1:415 FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3048
Practice Address - Country:US
Practice Address - Phone:831-233-8219
Practice Address - Fax:831-656-0330
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12531103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP12531Medicare ID - Type Unspecified