TANISHA BLAZE

Peer Specialist

Active Individual
NPI: 1104486471

Practice Address

14677 MERRILL AVE
Fontana, CA 92335

Phone: (951) 643-2340

Specialties

Specialty Code Primary License
Peer Specialist 175T00000X Yes -

Frequently Asked Questions

NPI 1104486471 is the National Provider Identifier for TANISHA BLAZE, a Peer Specialist provider located in Fontana, CA. This NPI was enumerated on June 18, 2019.
TANISHA BLAZE practices at 14677 MERRILL AVE, Fontana, CA 92335.

Quick Facts

NPI
1104486471
Type
Individual
Enumerated
Jun 18, 2019
Last Updated
Jun 18, 2019

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