Individual
CASSANDRA BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
18880 CHERRY VALLEY BLVD., TUOLUMNE, CA 95379
(209) 928-5400
(209) 928-5412
Mailing address
18880 CHERRY VALLEY BLVD., TUOLUMNE, CA 95379
(209) 928-5400
(209) 928-5412
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA15883
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA15883
STATE LICENSE
CA
05
—
THP71070F
—
CA
Enumeration date
06/15/2006
Last updated
04/23/2008
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