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General NPI Number Information
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NPI Number | 1619688868
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Entity Type | Individual
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Provider Name | BLAKE ANDREW OHM DNP CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/08/2022
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Last Update Date | 10/27/2023
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Provider Practice Location Address
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Address Line | 4867 W SUNSET BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90027-5969
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Country | US
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Telephone | 833-574-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 950 VENICE BLVD APT F
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City | VENICE
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State | CA
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Zip | 90291-4962
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Country | US
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Telephone | 817-565-8190
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 95001936
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License Number State | CA
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