Blayne Michael Vidrine

Primary specialty

Surgical TechnologistTaxonomy code 246ZS0410X

Practice address

9850 Genesee Ave Ste 210
La Jolla, CA 92037-1206

Phone

(858) 535-1075

Fax

(858) 452-3283

NPI assigned

Nov 4, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635984000000",
    "number": "1760147656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9850 GENESEE AVE STE 210",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371206",
            "telephone_number": "858-535-1075",
            "fax_number": "858-452-3283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9850 GENESEE AVE STE 210",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371206",
            "telephone_number": "858-535-1075",
            "fax_number": "858-452-3283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIDRINE",
        "first_name": "BLAYNE",
        "middle_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-04",
        "last_updated": "2021-11-04",
        "certification_date": "2021-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZS0410X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Technologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zhanna Verkh, M.D.
• Julie Vermeers, PHYSICIAN ASSISTANT
• Annie Schimpff Versteeg, IBCLC, RLC
• Samantha Jane Vesling, RDN, CNSC
• Meredith Victor, DPT
• Joseph Francis Viglotti, MD
• Laura Ann Vilardi, NP
• Heather Renee Villani, M.D.
• Benito Villanueva, MD
• Michael Villanueva, PHD

• Surgical Technologist in La Jolla, CA
• Providers in La Jolla, CA by specialty
• Surgical Technologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.