Individual provider · NPI-1

Dr. Scott Lee Bluck, D.O.

Family Medicine · La Mesa, CA

NPI number1467644187
StatusActive
Last updated in NPPESDec 1, 2021

Details

NPI
1467644187
Entity type
Individual (NPI-1)
Name
Dr. Scott Lee Bluck
Credential
D.O.
Sex
Male
Sole proprietor
Yes
Enumeration date
Aug 16, 2007
Certification date
Dec 1, 2021
Last updated
Dec 1, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine20A9096CAYes

Practice location

8010 Parkway Dr
Dept Of Family Medicine
La Mesa, CA 91942-2104

Phone 619-528-6111

Mailing address

855 Beech St
Apt 207
San Diego, CA 92101-2885

Phone 619-992-5446

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