Type not stated
Screen this subjectAndre Vergene Blaylock
Debarred entityUnited States. Named in 1 sanctions listing.
Summary
License number: G-51438
Sanctions and listings1
- Effective
- 17 Jul 2014
Official designation
California Department of Human servicesUS Delaware Medicaid Sanctioned ProvidersUnited States
Federal and CA indefinite suspension Criminal Conviction
Identifiers2
| Identifier | Number |
|---|---|
| NPI number | 1235287160 |
| Registration number | 00G514380 |
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