Provider Demographics
NPI:1093574345
Name:MACKIN, BLAIR MONIQUE
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:MONIQUE
Last Name:MACKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 ASHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-5343
Mailing Address - Country:US
Mailing Address - Phone:925-826-4025
Mailing Address - Fax:
Practice Address - Street 1:1418 ASHWOOD DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-5343
Practice Address - Country:US
Practice Address - Phone:925-826-4025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker