Provider Demographics
NPI:1861595415
Name:BLANKENSHIP, DABNEY (PHD)
Entity type:Individual
Prefix:DR
First Name:DABNEY
Middle Name:
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 NUTMEG PLACE
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-2597
Mailing Address - Country:US
Mailing Address - Phone:714-751-8110
Mailing Address - Fax:714-918-0322
Practice Address - Street 1:1520 NUTMEG PLACE
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-2597
Practice Address - Country:US
Practice Address - Phone:714-751-8110
Practice Address - Fax:714-918-0322
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16602103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL166020Medicare UPIN