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Blaze Gannon, PA-C
NPI 1588764245 · Physician Assistant · Colton, CA
Blaze Gannon, PA-C is a Physician Assistant provider in Colton, CA (NPI 1588764245).
Provider details
- NPI number
- 1588764245
- Entity type
- Individual
- Primary specialty
- Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- License
- PA18462 (CA)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
400 N Pepper Ave
Orthopaedic Admin
Colton, CA 92324-1801
Phone: (909) 580-6330
Street-level locationGet directions
Mailing address
1901 W Lugonia Ave Ste 230
Redlands, CA 92374-9705
Registry dates
- Enumerated
- 2006-09-23
- Last updated
- 2010-02-08
Frequently asked questions
- What is Blaze Gannon's NPI number?
- Blaze Gannon's National Provider Identifier (NPI) is 1588764245, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What is Blaze Gannon's specialty?
- Blaze Gannon is listed in the NPPES registry with a primary specialty of Physician Assistant (Physician Assistants & Advanced Practice Nursing Providers).
- Where is Blaze Gannon located?
- Blaze Gannon's practice location on file with NPPES is 400 N Pepper Ave, Colton, CA 92324-1801.
- What is Blaze Gannon's phone number?
- The practice phone number listed in the NPPES registry for Blaze Gannon is (909) 580-6330.
- Is Blaze Gannon's NPI active?
- Yes — Blaze Gannon's NPI (1588764245) is active in the NPPES registry as of the last update on 2010-02-08.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.