Active NPI
Raylene Blandino, P.A.
- Surgical Physician Assistant
- Lodi, CA
National Provider Identifier
1083636401
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- Practice address
- 801 S Ham LN Ste a
Lodi, CA 95242-7502 - Phone
- (209) 333-3376
- NPI assigned
- Jul 24, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | Primary | ||
| Physician Assistant | 363A00000X | PA16850 | CA |
Addresses
Primary practice location
801 S Ham LN Ste a
Lodi, CA 95242-7502
Mailing address
50 S San Mateo Dr
#350
San Mateo, CA 94401-3857
Other practice location 1
50 S San Mateo Dr
#350
San Mateo, CA 94401-3857
Phone (650) 342-3225
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA16850 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| California Skin Institute, a Medical Corporation | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
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- Mountain View, CA
- NPI 1154527901
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732579200000",
"number": "1083636401",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 S SAN MATEO DR",
"address_2": "#350",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944013857"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 S HAM LN STE A",
"city": "LODI",
"state": "CA",
"postal_code": "952427502",
"telephone_number": "209-333-3376"
}
],
"practiceLocations": [
{
"address_1": "50 S San Mateo Dr",
"address_2": "#350",
"address_purpose": "LOCATION",
"city": "San Mateo",
"state": "CA",
"postal_code": "944013857",
"country_code": "US",
"telephone_number": "650-342-3225",
"fax_number": "650-342-3220",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BLANDINO",
"first_name": "RAYLENE",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-24",
"last_updated": "2024-11-26",
"certification_date": "2024-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": null,
"license": null,
"primary": true
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA16850",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lodi, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.