Provider Demographics
NPI:1013749837
Name:BLUNT, GARY ELDON (RN)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:ELDON
Last Name:BLUNT
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:5315 TORRANCE BLVD STE B1
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4011
Mailing Address - Country:US
Mailing Address - Phone:800-829-8660
Mailing Address - Fax:562-402-3336
Practice Address - Street 1:5121 KLUMP AVE APT 214
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-4904
Practice Address - Country:US
Practice Address - Phone:424-731-2249
Practice Address - Fax:562-402-3336
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA818001163WH0200X, 163WH1000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice