Individual
BLAINE ROBERT LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
431 W LAMBERT RD STE 310, BREA, CA 92821-3918
(714) 325-7110
(949) 346-4026
Mailing address
2375 E IMPERIAL HWY # 1137, BREA, CA 92821-6112
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95027984
CA
Other
Enumeration date
11/10/2023
Last updated
04/24/2024
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