Provider Demographics
NPI:1396702932
Name:BLOCK, BAKER & GONZALEZ A MEDICAL CORPORATION
Entity type:Organization
Organization Name:BLOCK, BAKER & GONZALEZ A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-497-7508
Mailing Address - Street 1:227 W JANSS RD
Mailing Address - Street 2:250
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1848
Mailing Address - Country:US
Mailing Address - Phone:805-497-7508
Mailing Address - Fax:805-495-6834
Practice Address - Street 1:227 W JANSS RD
Practice Address - Street 2:250
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1848
Practice Address - Country:US
Practice Address - Phone:805-497-7508
Practice Address - Fax:805-495-6834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW3435Medicare ID - Type UnspecifiedMEDICARE PROVIDER #