Provider Demographics
NPI:1548663214
Name:BLANCA B. HAMPTON, M.D.
Entity type:Organization
Organization Name:BLANCA B. HAMPTON, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERTHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAPIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-991-3180
Mailing Address - Street 1:1110 W LA PALMA AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2822
Mailing Address - Country:US
Mailing Address - Phone:714-991-3120
Mailing Address - Fax:714-991-1957
Practice Address - Street 1:1110 W LA PALMA AVE STE 1
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2822
Practice Address - Country:US
Practice Address - Phone:714-991-3120
Practice Address - Fax:714-991-1957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45098208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1245263953Medicaid