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Tanisha Sharee Blaze
Peer Specialist in Fontana, California
NPI 1104486471

Tanisha Sharee Blaze is a Peer Specialist based in Moreno Valley, CA. Tanisha Sharee Blaze practices in Fontana, CA. The NPI Number for Tanisha Sharee Blaze is 1104486471 and holds a License No. (California).

The current practice location address for Tanisha Sharee Blaze is 14677 Merrill Ave, Fontana, CA and can be reached out via phone at 951-643-2340.

Location: 14677 Merrill Ave, Fontana, CA, 92557-7003
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1104486471
Provider Name
Tanisha Sharee Blaze
Credential
Provider Entity Type
Individual
Gender
Female
Address
14677 Merrill Ave, Fontana, CA, 92557-7003
Phone Number
951-643-2340
Fax Number
Provider Enumeration Date
06/18/2019
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
14677 Merrill Ave
City
Fontana
State
California
Zip
92335
Phone Number
951-643-2340
Fax Number
person
Provider Business Mailing Address Details
Address
14677 Merrill Ave
City
Fontana
State
California
Zip
92335
Phone Number
951-643-2340
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Peer Specialist
Speciality
-
Taxonomy
175T00000X
License No.
()
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
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