Individual
BRENT BLAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
1200 WILSHIRE BLVD STE 500, LOS ANGELES, CA 90017-1934
(213) 481-7464
Mailing address
643 GRANT ST APT F, SANTA MONICA, CA 90405-1248
(323) 356-2552
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
03/23/2007
Last updated
07/08/2007
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