Individual
JENNIFER LEE BLASE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPT
Contact information
Practice address
7000 MICHAEL CANLIS WAY, FRENCH CAMP, CA 95231-9781
(209) 468-4550
Mailing address
616 FIR ST, MANTECA, CA 95336-4850
(209) 603-0329
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
PT20194
CA
Other
Enumeration date
12/21/2012
Last updated
12/21/2012
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