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NPI Code Detail

MEDICARE: BLAKE GRIFFIN

MEDICARE: BLAKE GRIFFIN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care CoordinatorCA
2171400000XHealth & Wellness CoachCA

General Provider Information

NPI Number : 1639027758
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLAKE GRIFFIN
Provider Business Mailing Address
First Line : 1965 BIRKMONT DR
Second Line :
City : RANCHO CORDOVA
State : CA
Zip : 95742-6407
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1965 BIRKMONT DR
Second Line :
City : RANCHO CORDOVA
State : CA
Zip : 95742-6407
Country : US
Telephone Number : 916-294-9000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2026
Last Update Date : 03/17/2026

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Directions to “ BLAKE GRIFFIN ” Practice Location

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