Provider Demographics
NPI:1134518962
Name:BLANK, ALEXANDER (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:BLANK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:370 DEL NORTE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4142
Mailing Address - Country:US
Mailing Address - Phone:530-751-7201
Mailing Address - Fax:530-751-4244
Practice Address - Street 1:481 PLUMAS BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-5075
Practice Address - Country:US
Practice Address - Phone:530-751-7201
Practice Address - Fax:530-751-4244
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA52237363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant