Provider Demographics
NPI:1427775006
Name:BLADES, DARA ALODIE
Entity type:Individual
Prefix:
First Name:DARA
Middle Name:ALODIE
Last Name:BLADES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 EDGEWOOD ST APT 14
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-4457
Mailing Address - Country:US
Mailing Address - Phone:323-974-4684
Mailing Address - Fax:
Practice Address - Street 1:449 EDGEWOOD ST APT 14
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302-4457
Practice Address - Country:US
Practice Address - Phone:323-974-4684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN6P7N7R6246YC3302X
251E00000X, 374U00000X, 390200000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No246YC3302XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationCoding Specialist, Physician Office Based
No251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program