Provider Demographics
NPI:1447483342
Name:BLAKE, ALECIA CAMILLE (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:ALECIA
Middle Name:CAMILLE
Last Name:BLAKE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 E ARQUES AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-4521
Mailing Address - Country:US
Mailing Address - Phone:408-215-3403
Mailing Address - Fax:
Practice Address - Street 1:955 E ARQUES AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-4521
Practice Address - Country:US
Practice Address - Phone:408-215-3403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA636332083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine