Marilyn Blackmun, PDHAP

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

License

HAP11 Issued in CA

Practice address

2209 San Gorgonio Rd
La Canada, CA 91011-1352

Phone

(818) 957-1589

Fax

(818) 957-1589

NPI assigned

Apr 13, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790909349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2209 SAN GORGONIO RD",
            "city": "LA CANADA",
            "state": "CA",
            "postal_code": "910111352",
            "telephone_number": "818-957-1589",
            "fax_number": "818-957-1589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2209 SAN GORGONIO RD",
            "city": "LA CANADA",
            "state": "CA",
            "postal_code": "910111352",
            "telephone_number": "818-957-1589",
            "fax_number": "818-957-1589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKMUN",
        "first_name": "MARILYN",
        "name_prefix": "Mrs.",
        "credential": "PDHAP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "CA",
            "license": "HAP11",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "28993701",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL INS",
            "identifier": "133068",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael N Barnes, PHD
• Cathie Bautista, MSW, LCSW
• Elizabeth Coplin Bender, P.T.
• Parambir Bhatti, DO
• Susan Carol Billens-Ivory, PH.D.
• Body Connection Inc (Hailey Paton Pilates and Physical Therapy)
• Maryam Bonyadian
• Sue Jennifer Breland, DPT
• Amy Burdick, M.S., LMFT
• C.M.I. Drug Corporation (Cal-Med Pharmacy West)

• Dental Hygienist in La Canada, CA
• Providers in La Canada, CA by specialty
• Dental Hygienist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.