Individual
DR. BLAKE ANDREW WYLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
23181 VERDUGO DR STE 103A, LAGUNA HILLS, CA 92653-1313
(949) 366-1053
Mailing address
2721 WASHINGTON STREET, JULIAN, CA 92036
(760) 765-1223
(760) 765-1278
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20A11088
CA
Other
Enumeration date
08/25/2010
Last updated
03/31/2021
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