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Blake Song
Student in an Organized Health Care Education/Training Program in Costa Mesa, California
NPI 1114660891

Blake Song is a Student in an Organized Health Care Education/Training Program based in Lawndale, CA. Blake Song practices in Costa Mesa, CA. The NPI Number for Blake Song is 1114660891 and holds a License No. (California).

The current practice location address for Blake Song is 940 S Coast Dr Ste 225, Costa Mesa, CA and can be reached out via phone at 949-743-1457.

Location: 940 S Coast Dr Ste 225, Costa Mesa, CA, 90260-2828
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1114660891
Provider Name
Blake Song
Credential
Provider Entity Type
Individual
Gender
Male
Address
940 S Coast Dr Ste 225, Costa Mesa, CA, 90260-2828
Phone Number
949-743-1457
Fax Number
Provider Enumeration Date
04/19/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
940 S Coast Dr Ste 225
City
Costa Mesa
State
California
Zip
92626-7757
Phone Number
949-743-1457
Fax Number
person
Provider Business Mailing Address Details
Address
940 S Coast Dr Ste 225
City
Costa Mesa
State
California
Zip
92626-7757
Phone Number
949-743-1457
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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