Healthcare Provider Details

I. General information

NPI: 1366374282
Provider Name (Legal Business Name): BLEUX ONYX HEALTH & WELLNESS A PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 S KERCKHOFF AVE
SAN PEDRO CA
90731-6626
US

IV. Provider business mailing address

2830 S KERCKHOFF AVE
SAN PEDRO CA
90731-6626
US

V. Phone/Fax

Practice location:
  • Phone: 949-436-5536
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TANISHA RENEE RAGLAND
Title or Position: PRESIDENT & CEO
Credential: PMHNP-BC, DNP
Phone: 585-721-5686