Provider Demographics
NPI:1104060003
Name:BOCK, VENUS VENICIA (IDMT)
Entity type:Individual
Prefix:
First Name:VENUS
Middle Name:VENICIA
Last Name:BOCK
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 WIFORD HALL LOOP
Mailing Address - Street 2:BLDG 4554
Mailing Address - City:JBSA LACKLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78236
Mailing Address - Country:US
Mailing Address - Phone:210-808-5407
Mailing Address - Fax:
Practice Address - Street 1:133 CANYON VIS
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-3373
Practice Address - Country:US
Practice Address - Phone:719-331-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians