Sonny Blakley I
Individual provider Active NPI Counselor · San Jacinto, CA
NPI 1851782908 · NPPES record last updated Feb 11, 2015
Key facts
- NPI
- 1851782908
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 102 W Main St
San Jacinto, CA 92583-4121 - Phone
- (951) 357-5463
- NPI assigned
- Feb 11, 2015
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
102 W Main St
San Jacinto, CA 92583-4121
Mailing address
102 W Main St
San Jacinto, CA 92583-4121
Phone (951) 357-5463
Other providers in San Jacinto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 11, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.