Active NPI
Robert C Blaine, DPM
- Podiatrist
- Anaheim, CA
National Provider Identifier
1215901244
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- E3369
- Practice address
- 1717 E Lincoln Ave
Anaheim, CA 92805-4345 - Phone
- (714) 635-2642
- Fax
- (714) 635-8547
- NPI assigned
- Feb 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | E3369 | CA | Primary |
Addresses
Primary practice location
1717 E Lincoln Ave
Anaheim, CA 92805-4345
Mailing address
16702 Valley View Ave
La Mirada, CA 90638-5824
Phone (714) 367-5360
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E3369 | CA | MD | Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1499040000000",
"number": "1215901244",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16702 VALLEY VIEW AVE",
"city": "LA MIRADA",
"state": "CA",
"postal_code": "906385824",
"telephone_number": "714-367-5360",
"fax_number": "714-635-5428"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1717 E LINCOLN AVE",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928054345",
"telephone_number": "714-635-2642",
"fax_number": "714-635-8547"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAINE",
"first_name": "ROBERT",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-02-15",
"last_updated": "2017-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "CA",
"license": "E3369",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anaheim, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.