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General NPI Number Information
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NPI Number | 1063926103
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Entity Type | Individual
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Provider Name | LISA ANTIONETTE BLAZIO CATC I
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Gender | Female
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Dates
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Enumeration Date | 11/28/2017
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 3828 W CARSON ST STE 100
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City | TORRANCE
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State | CA
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Zip | 90503-6702
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Country | US
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Telephone | 310-787-1335
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Fax | 562-987-4586
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Provider Business Mailing Address
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Address Line | 3828 W CARSON ST STE 100
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City | TORRANCE
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State | CA
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Zip | 90503-6702
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Country | US
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Telephone | 310-787-1335
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Fax | 562-987-4586
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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