Provider Demographics
NPI:1316338718
Name:BLATTLER, RANDOLPH DALE (RN, RNFA)
Entity type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:DALE
Last Name:BLATTLER
Suffix:
Gender:M
Credentials:RN, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4647 ZION AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2507
Mailing Address - Country:US
Mailing Address - Phone:619-528-5000
Mailing Address - Fax:
Practice Address - Street 1:8624 CARLTON OAKS DR
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-2214
Practice Address - Country:US
Practice Address - Phone:619-851-7625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-07
Last Update Date:2015-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA547610163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant