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General NPI Number Information
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NPI Number | 1962527606
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Entity Type | Organization
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Legal Business Name | BASKERVILLE, BENNETT, BLOCK & LIU, A MEDICAL CORP
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 252 GREEN VALLEY RD
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City | FREEDOM
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State | CA
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Zip | 95019-3138
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Country | US
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Telephone | 831-475-7442
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Fax | 831-475-7417
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Provider Business Mailing Address
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Address Line | 4145 CLARES ST SUITE A
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City | CAPITOLA
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State | CA
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Zip | 95010-2053
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Country | US
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Telephone | 831-475-7442
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Fax | 831-475-7417
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES BENNETT
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Credential | M.D.
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Telephone | 831-763-4310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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