Individual
MR. ANDRE ANTHONY BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
2 W FERN AVE, REDLANDS, CA 92373-5916
(909) 793-3311
(909) 335-4190
Mailing address
PO BOX 10069, SAN BERNARDINO, CA 92423-0069
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA16708
CA
Other
Enumeration date
10/31/2005
Last updated
02/03/2020
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