Healthcare Provider Details

I. General information

NPI: 1497814115
Provider Name (Legal Business Name): STEVEN MICHAEL BLIZZARD PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 SUNRISE BLVD SUITE 2500
CITRUS HEIGHTS CA
95610-2300
US

IV. Provider business mailing address

625 FAIR OAKS AVE STE 270
SOUTH PASADENA CA
91030-5801
US

V. Phone/Fax

Practice location:
  • Phone: 916-722-2227
  • Fax: 877-860-5422
Mailing address:
  • Phone: 626-346-2455
  • Fax: 626-639-3005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA11136
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: