Healthcare Provider Details

I. General information

NPI: 1932874245
Provider Name (Legal Business Name): ALKENIA BLACKMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 LEMON ST STE 500
RIVERSIDE CA
92501-3374
US

IV. Provider business mailing address

3200 MOTOR AVE
LOS ANGELES CA
90034-3740
US

V. Phone/Fax

Practice location:
  • Phone: 951-530-1299
  • Fax: 951-405-8029
Mailing address:
  • Phone: 310-836-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSB94027297
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: