Blake Song is a student in an organized health care education training program in Costa Mesa, CA. The provider is an individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. Blake Song NPI is 1114660891. The provider is registered as an individual entity type.
The NPPES NPI record indicates the provider is a male.
The provider's business location address is:
940 S COAST DR STE 225
COSTA MESA, CA
ZIP 92626-757
Phone: (949) 743-1457
The enumeration date for this NPI number is 4/19/2022 and was last updated on 4/19/2022.