# ISC SAN PEDRO BLASSER CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821130113
- **Authorized official:** MR. MARVIN ANTONIO PENA (CLINIC SUPERVISOR)
- **Authorized official phone:** (310) 732-7500

## Contact information

- **Practice address:** 1001 S SEASIDE AVE, SAN PEDRO, CA 90731-7333
- **Practice address phone:** (310) 732-7500
- **Practice address fax:** (310) 732-7519
- **Mailing address:** 1001 S SEASIDE AVE, SAN PEDRO, CA 90731-7333
- **Mailing address phone:** (310) 732-7500
- **Mailing address fax:** (310) 732-7519

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1100X | Military/U.S. Coast Guard Outpatient Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/13/2007
- **Last updated:** 08/22/2020