Individual provider · Type 1 NPI

Blake Song

Student in an Organized Health Care Education/Training Program · Costa Mesa, CA

NPI number 1114660891 Active

Practice location

940 S Coast Dr Ste 225
Costa Mesa, CA 92626-7757

Call (949) 743-1457 Map

Mailing address

4711 W 166th St
Lawndale, CA 90260-2828

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: 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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About NPI 1114660891

Blake Song's National Provider Identifier is 1114660891, issued on Apr 19, 2022. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Costa Mesa, CA. The record was last updated on Apr 19, 2022.