Individual
NORMA LYNN BLACKWATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1125 W 6TH ST, SUITE 103, LOS ANGELES, CA 90017-1833
(213) 202-3970
(213) 975-9257
Mailing address
1125 W 6TH ST, SUITE 103, LOS ANGELES, CA 90017-1833
(213) 202-3970
(213) 975-9257
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
G83912
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G839120
—
CA
Enumeration date
03/20/2007
Last updated
12/08/2011
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