Provider Demographics
NPI:1033223300
Name:BLADA, RICHARD LINN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LINN
Last Name:BLADA
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2389 FOUNTAIN CREST LN
Mailing Address - Street 2:#13
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-5777
Mailing Address - Country:US
Mailing Address - Phone:805-794-0557
Mailing Address - Fax:818-712-2100
Practice Address - Street 1:6301 OWENSMOUTH AVE
Practice Address - Street 2:#200 THE WELLNESS CENTER
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2216
Practice Address - Country:US
Practice Address - Phone:818-704-2914
Practice Address - Fax:818-712-2100
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CA13776363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical