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NPI Code Detail

MEDICARE: BLAKEMORE INSPIRED WELLNESS, MARRIAGE AND FAMILY SERVICES, PC.

MEDICARE: BLAKEMORE INSPIRED WELLNESS, MARRIAGE AND FAMILY SERVICES, PC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1164394060
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLAKEMORE INSPIRED WELLNESS, MARRIAGE AND FAMILY SERVICES, PC.
Provider Business Mailing Address
First Line : 3200 E GUASTI RD STE 144
Second Line :
City : ONTARIO
State : CA
Zip : 91761-8661
Country : US
Telephone Number : 714-519-6704
Fax Number :
Provider Business Practice Location Address
First Line : 3200 E GUASTI RD STE 144
Second Line :
City : ONTARIO
State : CA
Zip : 91761-8661
Country : US
Telephone Number : 714-519-6704
Fax Number :
Authorized Official
Title or Position : OFFICER/ PRESIDENT
Name : DR. SHARAYZA RACHAEL BLAKEMORE
Credential : LMFT
Telephone Number : 714-519-6704
Provider Enumeration Date : 09/19/2025
Last Update Date : 07/01/2026

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