Healthcare Provider Details

I. General information

NPI: 1255703831
Provider Name (Legal Business Name): KAREN BLOCH, MFT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2015
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3252 HOLIDAY CT SUITE 227
LA JOLLA CA
92037-0027
US

IV. Provider business mailing address

3252 HOLIDAY CT SUITE 227
LA JOLLA CA
92037-0027
US

V. Phone/Fax

Practice location:
  • Phone: 858-455-1355
  • Fax: 858-455-5556
Mailing address:
  • Phone: 858-455-1355
  • Fax: 858-455-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT38192
License Number StateCA

VIII. Authorized Official

Name: MS. KAREN BLOCH
Title or Position: INDEPENDENT SOLE PROVIDER
Credential: MFT
Phone: 858-455-1355