MR. GORDON J. BLACKNELL (NPI# 1831229186) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831229186 |
| Entity Type | Individual |
| Full Name | MR. GORDON J. BLACKNELL |
| Practice Address |
12901 Venice Blvd Los Angeles CA 90066-3509 |
| Practice Telephone | 3103903611 |
| Practice Fax Number | 3103904906 |
| Mailing Telephone | 3103903611 |
| Mailing Fax Number | 3103904906 |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225400000X | Rehabilitation Practitioner | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
12901 VENICE BLVD |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90066-3509 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649300898 | Westside Center for Independent Living | Social Worker | 12901 Venice Blvd, Los Angeles, CA 90066-3509 | 2007-03-06 |
| 1285275339 | Jay Aquino | Case Manager/Care Coordinator | 12901 Venice Blvd, Los Angeles, CA 90066-3509 | 2019-09-30 |
| 1093366197 | Jose Gonzalez | Case Manager/Care Coordinator | 12901 Venice Blvd, Los Angeles, CA 90066-3509 | 2019-09-20 |
| 1558912592 | Abigail Gabriel | Case Manager/Care Coordinator | 12901 Venice Blvd, Los Angeles, CA 90066-3509 | 2019-09-20 |
| 1386294452 | Maria Del Carmen Rosales | Case Manager/Care Coordinator | 12901 Venice Blvd, Los Angeles, CA 90066-3509 | 2019-09-19 |
| 1679078869 | Judith Davila | Case Manager/Care Coordinator | 12901 Venice Blvd, Los Angeles, CA 90066-3509 | 2018-03-28 |
| 1902324346 | Kenyatta Clark | Case Manager/Care Coordinator | 12901 Venice Blvd, Los Angeles, CA 90066-3509 | 2017-09-06 |
| 1063930410 | Dina Garcia | Case Manager/Care Coordinator | 12901 Venice Blvd, Los Angeles, CA 90066-3509 | 2017-09-06 |
| 1083132427 | Jacqueline Quiroba | Case Manager/Care Coordinator | 12901 Venice Blvd, Los Angeles, CA 90066-3509 | 2017-09-06 |
| 1679091011 | Jose Ulloa | Case Manager/Care Coordinator | 12901 Venice Blvd, Los Angeles, CA 90066-3509 | 2017-09-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194330274 | Marilyn S Zweifach | Psychologist | 3606 Barry Avenue, Los Angeles, CA 90066 | 2020-09-15 |
| 1073167458 | Rosario Tabares | Marriage & Family Therapist | 4173 Inglewood Blvd., Los Angeles, CA 90066 | 2019-07-24 |
| 1396200739 | Ruzziel Pio | Licensed Vocational Nurse | 4344 Harding Avenue, Los Angeles, CA 90066 | 2019-02-08 |
| 1164992731 | Erfan Nazeri | Student in an Organized Health Care Education/Training Program | 3101 Sawtelle Blvd, Apt 128, Los Angeles, CA 90066 | 2018-11-27 |
| 1972096600 | Tricia Kim Ann Walters | Licensed Vocational Nurse | 1233 S. La Cienega Blvd, Los Angeles, CA 90066 | 2018-06-07 |
| 1174015622 | Nicole Hiorns | Occupational Therapist | 11605 Washington Place, Los Angeles, CA 90066 | 2018-05-31 |
| 1225549934 | Gary Sattler | Psychoanalyst | 3133 Federal Ave., Los Angeles, CA 90066 | 2017-10-20 |
| 1669991568 | Nexus Recovery Services, LLC | Clinic/Center | 11515 Washington Blvd, Culver City, CA 90066 | 2017-09-12 |
| 1336669381 | Andrea Michelle Bakke | Dentist | 3636 Rosewood Ave, Los Angeles, CA 90066 | 2017-06-21 |
| 1659820686 | Pegah Ghassemi Bakhtiari Dds Inc | Dentist | 12756 West Washington Blvd, Los Angeles, CA 90066 | 2016-10-03 |
| Find all providers in zip 90066 | ||||
| Taxonomy Code | 225400000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Rehabilitation Practitioner |
| A health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861013757 | Terrisa Noel-rivera Luna | Rehabilitation Practitioner | 11303 Wilshire Blvd Bld 116, Los Angeles, CA 90025-5069 | 2020-05-01 |
| 1063046795 | Leanne Margaret Cremin | Rehabilitation Practitioner | 2285 Westwood Blvd, Los Angeles, CA 90064-2017 | 2020-03-03 |
| 1720610421 | Ronmoe Inc | Rehabilitation Practitioner | 2025 Westwood Blvd, Los Angeles, CA 90025-6328 | 2020-02-10 |
| 1104390723 | Joana Rodriguez | Rehabilitation Practitioner | 3731 Stocker St., Suite 105, Los Angeles, CA 90008 | 2019-01-16 |
| 1376055145 | Gentle F Carcamo | Rehabilitation Practitioner | 3731 Stoker Street, Ste. 105, Los Angeles, CA 90008 | 2017-11-01 |
| 1114445848 | Claudia Melgar | Rehabilitation Practitioner | 1540 Alcazar St # St133, Los Angeles, CA 90089-0080 | 2017-09-01 |
| 1134646516 | Maria Salas | Rehabilitation Practitioner | 333 S Beaudry Ave., Los Angeles, CA 90017 | 2017-08-25 |
| 1295257111 | Freddy Pablo | Rehabilitation Practitioner | 3580 Wilshire Blvd., Ste. 800, Los Angeles, CA 90010 | 2017-07-12 |
| 1356893796 | Rosemary Marroquin | Rehabilitation Practitioner | 511 N Harvard Blvd, Los Angeles, CA 90004-1906 | 2016-11-02 |
| 1902356520 | Aida Kimberly Escobar | Rehabilitation Practitioner | 2715 E 5th St, Los Angeles, CA 90033-4422 | 2016-10-06 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90066 |
Please comment or provide details below to improve the information on MR. GORDON J. BLACKNELL.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.