1821029414 NPI number — MRS. CHRISTINA MARIE BROCK M.S.

Table of content: MRS. CHRISTINA MARIE BROCK M.S. (NPI 1821029414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821029414 NPI number — MRS. CHRISTINA MARIE BROCK M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROCK
Provider First Name:
CHRISTINA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821029414
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9350 CAMPUS POINT DR, 2D
Provider Second Line Business Mailing Address:
#0996
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92037-1300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-657-7216
Provider Business Mailing Address Fax Number:
858-657-7201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9350 CAMPUS POINT DR, 2D
Provider Second Line Business Practice Location Address:
#0996
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92037-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-657-7216
Provider Business Practice Location Address Fax Number:
858-657-7201
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2005036 . This is a "ABGC CERTIFICATE NUMBER" identifier . This identifiers is of the category "OTHER".




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