Organization
ISC SAN PEDRO BLASSER CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARVIN ANTONIO PENA (CLINIC SUPERVISOR)
(310) 732-7500
Entity
Organization
Contact information
Practice address
1001 S SEASIDE AVE, SAN PEDRO, CA 90731-7333
(310) 732-7500
(310) 732-7519
Mailing address
1001 S SEASIDE AVE, SAN PEDRO, CA 90731-7333
(310) 732-7500
(310) 732-7519
Taxonomy
Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
Primary
—
—
Other
Enumeration date
02/13/2007
Last updated
08/22/2020
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