MEDICARE: PAULETTE BLALOCK

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103K00000X	Behavior Analyst
2	3747A0650X	Attendant Care Provider
3	376J00000X	Homemaker
4	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1710512439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULETTE BLALOCK

Provider Business Mailing Address
First Line	:	4680 S EASTERN AVE STE H
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6192
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4680 S EASTERN AVE STE H
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6192
Country	:	US
Telephone Number	:	702-476-9283
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2020
Last Update Date	:	08/01/2024

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Directions to “ PAULETTE BLALOCK ” Practice Location

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