Healthcare Provider Details

I. General information

NPI: 1831087899
Provider Name (Legal Business Name): KRISTY BLASCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13944 S ACADEMY AVE
KINGSBURG CA
93631-9207
US

IV. Provider business mailing address

2600 12TH AVE
KINGSBURG CA
93631-1071
US

V. Phone/Fax

Practice location:
  • Phone: 559-556-0030
  • Fax:
Mailing address:
  • Phone: 559-859-7232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: