Provider Demographics
NPI:1790678027
Name:BLON, GRANT A JR (CMPSS)
Entity type:Individual
Prefix:MR
First Name:GRANT
Middle Name:A
Last Name:BLON
Suffix:JR
Gender:M
Credentials:CMPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 W MARCH LN
Mailing Address - Street 2:STE 2
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2105 W MARCH LN
Practice Address - Street 2:STE 2
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6422
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty