Provider Demographics
NPI:1649047101
Name:OLDFIELD, BLAKE (PSYD)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:
Last Name:OLDFIELD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 MARCAR LN
Mailing Address - Street 2:
Mailing Address - City:RANCHO MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1603
Mailing Address - Country:US
Mailing Address - Phone:949-292-8672
Mailing Address - Fax:
Practice Address - Street 1:26 MARCAR LN
Practice Address - Street 2:
Practice Address - City:RANCHO MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92694-1603
Practice Address - Country:US
Practice Address - Phone:949-292-8672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPPS103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool