Provider Demographics
NPI:1861752156
Name:BROWN, BLAKE CUE (MD)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:CUE
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 CARNEGIE LN
Mailing Address - Street 2:APT C
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-5371
Mailing Address - Country:US
Mailing Address - Phone:951-313-7665
Mailing Address - Fax:
Practice Address - Street 1:2020 ZONAL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0121
Practice Address - Country:US
Practice Address - Phone:323-226-2113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program