NPIMap

Organization Active NPI

Isc San Pedro Blasser Clinic

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • San Pedro, CA
National Provider Identifier
1821130113
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military/U.S. Coast Guard Outpatient Clinic/CenterTaxonomy code 261QM1100X
Legal business name
ISC SAN PEDRO BLASSER CLINIC
Practice address
1001 S Seaside Ave
San Pedro, CA 90731-7333
Phone
(310) 732-7500
Fax
(310) 732-7519
NPI assigned
Feb 13, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Marvin Antonio PenaNPI 1790756252
Title
Clinic Supervisor
Phone
(310) 732-7500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Military/U.S. Coast Guard Outpatient Clinic/Center 261QM1100X Primary

Addresses

Primary practice location

1001 S Seaside Ave
San Pedro, CA 90731-7333

Mailing address

1001 S Seaside Ave
San Pedro, CA 90731-7333
Phone (310) 732-7500

National Provider Directory

National Provider Directory
Tax ID family
US Coast Guard65 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 8

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

1001 S Seaside Ave
San Pedro, CA 90731
Phone (310) 732-7500

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1821130113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 S SEASIDE AVE",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907317333",
            "telephone_number": "310-732-7500",
            "fax_number": "310-732-7519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 S SEASIDE AVE",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907317333",
            "telephone_number": "310-732-7500",
            "fax_number": "310-732-7519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISC SAN PEDRO BLASSER CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PENA",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_middle_name": "ANTONIO",
        "authorized_official_title_or_position": "CLINIC SUPERVISOR",
        "authorized_official_telephone_number": "310-732-7500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military/U.S. Coast Guard Outpatient",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Pedro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.