Most Relevant Information
Provider Data
| NPI Number: | 1003595752 |
| Provider Name: | BLAKE EDWARD LASZLO |
| Entity Type: | Individual |
| Taxonomy Code: | 175T00000X |
| Specialty: | Peer Specialist |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/11/2023 |
| Last Updated: | 10/22/2024 |
Provider Practice Location
3125 MYERS ST
RIVERSIDE
CA
925035527
Practice Location Phone/Fax
| Phone: | 7149436505 |
| Fax: |
Provider Mailing Location
3125 MYERS ST
RIVERSIDE
CA
925035527
Provider Mailing Phone/Fax
| Phone: | 7149436505 |
| Fax: |