Individual
MATT MACARTHUR VAN BLAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
116 AGNES AVE, SANTA MARIA, CA 93458-2838
(805) 457-3724
Mailing address
116 AGNES AVE, SANTA MARIA, CA 93458-2838
(805) 457-3724
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
37368
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1205480563
AGNES AVE
—
Enumeration date
03/21/2018
Last updated
01/12/2022
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