Individual
RANDY BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
550 S VERMONT AVE FL 10, LOS ANGELES, CA 90020-1912
(310) 217-7312
Mailing address
735 N NEIL ST, WEST COVINA, CA 91791-1120
(626) 780-4170
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
563948
CA
Other
Enumeration date
05/28/2014
Last updated
03/23/2021
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