Provider Demographics
NPI:1730390865
Name:BLODGETT, JUDY F (PA)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:F
Last Name:BLODGETT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-379-2915
Mailing Address - Fax:
Practice Address - Street 1:7291 BOULDER AVE
Practice Address - Street 2:SUITE #2C
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-3389
Practice Address - Country:US
Practice Address - Phone:909-862-4226
Practice Address - Fax:909-862-0319
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA1273363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA571720Medicare UPIN