| Luis M Blando Md Inc | |
|
222 E Clarion Dr Carson CA 90745-1514 | |
| (805) 487-3881 | |
| (805) 487-3963 |
| Full Name | Luis M Blando Md Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 222 E Clarion Dr, Carson, California |
| Authorized Official Name and Position | Gregorio De Grano (PRACTICE OWNER) |
| Authorized Official Contact | 8185168066 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Luis M Blando Md Inc 222 E Clarion Dr Carson CA 90745-1514 Ph: (805) 487-3881 | Luis M Blando Md Inc 222 E Clarion Dr Carson CA 90745-1514 Ph: (805) 487-3881 |
| NPI Number | 1578647269 |
|---|---|
| Provider Enumeration Date | 10/25/2006 |
| Last Update Date | 10/25/2025 |
| Medicare PECOS PAC ID | 8729176979 |
|---|---|
| Medicare Enrollment ID | O20071121000429 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578647269 | NPI | - | NPPES |
| 00C411270 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | C41127 (California) | Primary |
| Provider Name | Gary Proffett |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1932254570 PECOS PAC ID: 8628018868 Enrollment ID: I20101030000235 |
| Provider Name | Hermilito Villar |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1710946009 PECOS PAC ID: 4486729720 Enrollment ID: I20120305000235 |
| Provider Name | Gregorio De Grano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417392176 PECOS PAC ID: 6507005121 Enrollment ID: I20130611000838 |
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