Individual
MRS. BETHANY BLACKETER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1330 LAS TABLAS RD, TEMPLETON, CA 93465-9758
(805) 542-6700
(805) 542-6791
Mailing address
2050 S BLOSSER RD, SANTA MARIA, CA 93458-7310
(805) 361-8030
(805) 361-8097
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A69805
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A698050
—
CA
Enumeration date
08/30/2006
Last updated
06/23/2021
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