Provider Demographics
NPI:1457443368
Name:BLAINE, DENNIS PATRICK (PAC)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:PATRICK
Last Name:BLAINE
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 STANTON CT
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648
Mailing Address - Country:US
Mailing Address - Phone:916-543-9927
Mailing Address - Fax:
Practice Address - Street 1:3104 SUNSET BLVD #2B
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677
Practice Address - Country:US
Practice Address - Phone:916-624-0300
Practice Address - Fax:916-624-0631
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16607363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant