Individual
TYANNA LEIGH BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.T.(R)
Contact information
Practice address
650 E INDIAN SCHOOL RD # RF, PHOENIX, AZ 85012-1839
(602) 277-5551
Mailing address
10010 N 50TH AVE, GLENDALE, AZ 85302-2419
(623) 826-5388
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
Primary
CRT0000104107
AZ
Other
Enumeration date
02/18/2025
Last updated
02/18/2025
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