Basic Information
| Provider Information | |||||||||
| NPI: | 1003144247 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLANDO CAOAGAS | ||||||||
| FirstName: | EMILIA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LVN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8236 DRAIS WAY | ||||||||
| Address2: | |||||||||
| City: | ELK GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956244128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168495617 | ||||||||
| FaxNumber: | 9168751086 | ||||||||
| Practice Location | |||||||||
| Address1: | 4875 BROADWAY | ||||||||
| Address2: | 4875 BROADWAY | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958201500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168743573 | ||||||||
| FaxNumber: | 9168751086 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2009 | ||||||||
| LastUpdateDate: | 11/30/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | VN207949 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.