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NPI Code Detail

MEDICARE: JANEE BLACKBURN

MEDICARE: JANEE BLACKBURN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health WorkerCA
2390200000XStudent in an Organized Health Care Education/Training ProgramCA
3104100000XSocial WorkerASW124531CA

General Provider Information

NPI Number : 1043919376
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANEE BLACKBURN
Provider Business Mailing Address
First Line : 3576 ARLINGTON AVE STE 106
Second Line :
City : RIVERSIDE
State : CA
Zip : 92506-3907
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 440 CAJON ST
Second Line :
City : REDLANDS
State : CA
Zip : 92373-5955
Country : US
Telephone Number : 909-307-5777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2023
Last Update Date : 09/26/2024

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