Healthcare Provider Details

I. General information

NPI: 1235384785
Provider Name (Legal Business Name): MICHAEL R BLOCK M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 MONUMENT ST SUITE 210
PACIFIC PALISADES CA
90272-3800
US

IV. Provider business mailing address

970 MONUMENT ST SUITE 210
PACIFIC PALISADES CA
90272-3800
US

V. Phone/Fax

Practice location:
  • Phone: 310-459-4321
  • Fax: 310-459-5326
Mailing address:
  • Phone: 310-459-4321
  • Fax: 310-459-5326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL R BLOCK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-459-4321