Provider Demographics
NPI:1497814115
Name:BLIZZARD, STEVEN MICHAEL (PA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:MICHAEL
Last Name:BLIZZARD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 FAIR OAKS AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-5801
Mailing Address - Country:US
Mailing Address - Phone:626-346-2455
Mailing Address - Fax:626-639-3005
Practice Address - Street 1:7777 SUNRISE BLVD
Practice Address - Street 2:SUITE 2500
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-2300
Practice Address - Country:US
Practice Address - Phone:916-722-2227
Practice Address - Fax:877-860-5422
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11136363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01453363-DV5277OtherRAILROAD MEDICARE
CAEFF:02/20/13-NORWOODMedicaid
CAEFF:2/20/13-MARYSVILMedicaid
CAEFF:3/22/13-55THSTMedicaid
CAEFF: 3/22/13-CITRUSHMedicaid
CACA143096Medicare PIN
CAEFF:2/20/13-MARYSVILMedicaid
CAEFF:2/20/13-MARYSVILMedicaid