Healthcare Provider Details

I. General information

NPI: 1952239584
Provider Name (Legal Business Name): ALEXANDER BLAKE COBLIN LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 S EUCLID AVE
PASADENA CA
91101-2717
US

IV. Provider business mailing address

2028 N BEACHWOOD DR APT 202
LOS ANGELES CA
90068-3440
US

V. Phone/Fax

Practice location:
  • Phone: 202-510-1878
  • Fax:
Mailing address:
  • Phone: 202-510-1878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number100785
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: