Basic Information
| Provider Information | |||||||||
| NPI: | 1497814115 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLIZZARD | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 625 FAIR OAKS AVE STE 270 | ||||||||
| Address2: | |||||||||
| City: | SOUTH PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910305801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263462455 | ||||||||
| FaxNumber: | 6266393005 | ||||||||
| Practice Location | |||||||||
| Address1: | 7777 SUNRISE BLVD | ||||||||
| Address2: | SUITE 2500 | ||||||||
| City: | CITRUS HEIGHTS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956102300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167222227 | ||||||||
| FaxNumber: | 8778605422 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 03/30/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA11136 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | P01453363-DV5277 | 01 | CA | RAILROAD MEDICARE | OTHER | EFF:02/20/13-NORWOOD | 05 | CA | MEDICAID | EFF:2/20/13-MARYSVIL | 05 | CA | MEDICAID | EFF:3/22/13-55THST | 05 | CA | MEDICAID | EFF: 3/22/13-CITRUSH | 05 | CA | MEDICAID |