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General NPI Number Information
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NPI Number | 1477954006
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Entity Type | Individual
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Provider Name | MAELISE BLOSSE
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Gender | Female
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Dates
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Enumeration Date | 09/15/2014
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Last Update Date | 03/05/2019
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Provider Practice Location Address
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Address Line | 2090 EVANS LN
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City | SAN JOSE
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State | CA
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Zip | 95125-2072
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Country | US
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Telephone | 650-591-9623
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Fax |
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Provider Business Mailing Address
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Address Line | 610 ELM ST SUITE 212
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City | SAN CARLOS
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State | CA
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Zip | 94070-8401
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Country | US
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Telephone |
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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 | 98865
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License Number State | CA
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