Basic Information
| Provider Information | |||||||||
| NPI: | 1881856375 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLAKE | ||||||||
| FirstName: | APRIL | ||||||||
| MiddleName: | FAY | ||||||||
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| Credential: | ND | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 LARKSPUR LANDING CIR | ||||||||
| Address2: | SUTE 200 | ||||||||
| City: | LARKSPUR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949391757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155783095 | ||||||||
| FaxNumber: | 4152910489 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 LARKSPUR LANDING CIR | ||||||||
| Address2: | SUTE 200 | ||||||||
| City: | LARKSPUR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949391757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155783095 | ||||||||
| FaxNumber: | 4152910489 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2008 | ||||||||
| LastUpdateDate: | 06/26/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175F00000X | ND299 | CA | Y | Other Service Providers | Naturopath |
ID Information
| ID | Type | State | Issuer | Description | ND229 | 01 | CA | LICENSE | OTHER |