Provider Demographics
NPI:1275078958
Name:BLASCO, CALVIN JOHN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:CALVIN
Middle Name:JOHN
Last Name:BLASCO
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:1720 ELLINCOURT DR
Mailing Address - Street 2:10
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-2110
Mailing Address - Country:US
Mailing Address - Phone:760-880-2854
Mailing Address - Fax:619-878-2996
Practice Address - Street 1:207 S SANTA ANITA ST
Practice Address - Street 2:SUITE G-16
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1146
Practice Address - Country:US
Practice Address - Phone:626-300-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA95000604367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered