Blayne Michael Vidrine
Specialist/Technologist, Other, Surgical Technologist in La Jolla, CA. Individual provider (NPI-1).
NPI number1760147656
StatusActive
Last updated in NPPESNov 4, 2021
Details
- NPI
- 1760147656
- Entity type
- Individual (NPI-1)
- Name
- Blayne Michael Vidrine
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Nov 4, 2021
- Certification date
- Nov 4, 2021
- Last updated
- Nov 4, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 246ZS0410X | Specialist/Technologist, Other, Surgical Technologist | – | – | Yes |
Practice location
9850 Genesee Ave Ste 210La Jolla, CA 92037-1206
Phone 858-535-1075 · Fax 858-452-3283
Mailing address
9850 Genesee Ave Ste 210La Jolla, CA 92037-1206
Phone 858-535-1075 · Fax 858-452-3283
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