MEDICARE: WENDY NAN BLOCK L.C.S,W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCS14643	CA

General Provider Information

NPI Number	:	1033312822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY NAN BLOCK L.C.S,W.

Provider Business Mailing Address
First Line	:	3032 KEMPTON DR
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-4622
Country	:	US
Telephone Number	:	562-799-0747
Fax Number	:	562-799-0747

Provider Business Practice Location Address
First Line	:	4132 KATELLA AVE
Second Line	:	SUITE 206
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-3426
Country	:	US
Telephone Number	:	562-310-5505
Fax Number	:	562-799-0747

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	09/08/2022

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Directions to “ WENDY NAN BLOCK L.C.S,W.” Practice Location

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