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General NPI Number Information
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NPI Number | 1255066957
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Entity Type | Individual
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Provider Name | NICHOLAS BLASQUEZ
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Gender | Male
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Dates
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Enumeration Date | 07/18/2022
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 5607 MOUNT MURPHY ROAD
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City | GARDEN VALLEY
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State | CA
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Zip | 95633-9701
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Country | US
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Telephone | 530-333-9460
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Fax |
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Provider Business Mailing Address
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Address Line | 4980 HILLSDALE CIR STE ABC
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-5726
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Country | US
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Telephone | 408-623-7713
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | R184880922
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License Number State | CA
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