Individual
MR. BLAKE EDWARD LASZLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3125 MYERS ST, RIVERSIDE, CA 92503-5527
(714) 943-6505
Mailing address
3125 MYERS ST, RIVERSIDE, CA 92503-5527
(714) 943-6505
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
175T00000X
Peer Specialist
Primary
—
CA
Other
Enumeration date
07/11/2023
Last updated
10/22/2024
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