Healthcare Provider Details

I. General information

NPI: 1639097389
Provider Name (Legal Business Name): JOHN BLAKES CRANIAL PROSTHETICS AND HAIR, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 S FAIRFAX AVE SUITE 302
LOS ANGELES CA
90036-2186
US

IV. Provider business mailing address

145 S FAIRFAX AVE SUITE 200 PMB 17007849
LOS ANGELES CA
90036-2186
US

V. Phone/Fax

Practice location:
  • Phone: 855-546-3543
  • Fax:
Mailing address:
  • Phone: 855-546-3543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: SHERI FOSTER BLAKE
Title or Position: CEO
Credential:
Phone: 310-200-5949