Active NPI
Randy Blake, RN
- Psychiatric/Mental Health Registered Nurse
- Los Angeles, CA
National Provider Identifier
1881006674
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Registered Nurse
- License
- 563948
- Practice address
- 550 S Vermont Ave FL 10
Los Angeles, CA 90020-1912 - Phone
- (310) 217-7312
- NPI assigned
- May 28, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | 563948 | CA | Primary |
Addresses
Primary practice location
550 S Vermont Ave FL 10
Los Angeles, CA 90020-1912
Mailing address
735 N Neil St
West Covina, CA 91791-1120
Phone (626) 780-4170
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 563948 | CA | MD | Psychiatric/Mental Health Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1401235200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616457600000",
"number": "1881006674",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "735 N NEIL ST",
"city": "WEST COVINA",
"state": "CA",
"postal_code": "917911120",
"telephone_number": "626-780-4170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "550 S VERMONT AVE FL 10",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900201912",
"telephone_number": "310-217-7312"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAKE",
"first_name": "RANDY",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-05-28",
"last_updated": "2021-03-23",
"certification_date": "2021-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "163WP0808X",
"taxonomy_group": "",
"desc": "Registered Nurse, Psychiatric/Mental Health",
"state": "CA",
"license": "563948",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.