Blossom Dawn Vencer Aguirre, MS, PA-C
Individual provider Active NPI Physician Assistant · Santa Monica, CA
NPI 1235475005 · NPPES record last updated Mar 31, 2015
Key facts
- NPI
- 1235475005
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA22589 (CA)
- Practice address
- 1316 3Rd Street Promenade Ste 201
Santa Monica, CA 90401-1382 - Phone
- (800) 567-5544
- NPI assigned
- Dec 21, 2012
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA22589 | CA | MD | Physician Assistant |
Interoperability endpoints
- blossom.aguirre@398008301912068.direct.elationemr.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA22589 | CA | Yes |
Addresses
Primary practice location
1316 3Rd Street Promenade Ste 201
Santa Monica, CA 90401-1382
Mailing address
1316 3Rd Street Promenade Ste 201
Santa Monica, CA 90401-1382
Phone (800) 567-5544
Other providers in Santa Monica, CA
- Asal Askarinam Aghajani
- Mehrdad Aghajani
- Alpna Agrawal
- Nupur Agrawal
- Yesenia Aguilar Silvan
- Stephanie Marie Aguirre
- Anabelle Ahdoot
- Edmond Ahdoot
- Cynthia Elaine Ahlholm
- Lauren Ahlquist
All providers in Santa Monica, CA · Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.