Tanisha Sharee Blaze

NPI #1104486471 in Fontana, California

Provider Information

NPI Number: 1104486471
Entity Type: Individual
Name: Tanisha Sharee Blaze
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Peer Specialist
Enumeration Date: Jun 18, 2019
Last Updated: Jun 18, 2019

Practice Location

Address: 14677 MERRILL AVE
City: Fontana
State: California
ZIP Code: 92335
Phone: (951) 643-2340

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Peer Specialist	175T00000X	Primary

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