Healthcare Provider Details

I. General information

NPI: 1356264568
Provider Name (Legal Business Name): BLAKE WARNER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 WESTWOOD PLZ
LOS ANGELES CA
90095-8353
US

IV. Provider business mailing address

760 WESTWOOD PLZ
LOS ANGELES CA
90095-8353
US

V. Phone/Fax

Practice location:
  • Phone: 310-267-3377
  • Fax:
Mailing address:
  • Phone: 310-267-3377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number36878
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: