Provider Demographics
NPI:1477822427
Name:BLASZKIEWICZ, DANA LYNN
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LYNN
Last Name:BLASZKIEWICZ
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 1:7495 FARMDALE AVE
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-5750
Mailing Address - Country:US
Mailing Address - Phone:760-638-0139
Mailing Address - Fax:
Practice Address - Street 1:9047 ARROW RTE STE 170
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4434
Practice Address - Country:US
Practice Address - Phone:909-948-0396
Practice Address - Fax:909-760-0770
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator