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General NPI Number Information
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NPI Number | 1154960367
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Entity Type | Individual
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Provider Name | SHARAYZA RACHAEL BLAKEMORE LMFT, MBA
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Gender | Female
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Dates
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Enumeration Date | 01/06/2020
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 3491 CONCOURS
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City | ONTARIO
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State | CA
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Zip | 91764-5916
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Country | US
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Telephone | 909-284-4504
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Fax |
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Provider Business Mailing Address
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Address Line | 12777 ROYAL PALM LN
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City | RIVERSIDE
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State | CA
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Zip | 92503-7077
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Country | US
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Telephone | 909-441-1904
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 150151
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License Number State | CA
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