Provider Demographics
NPI:1437434545
Name:BLOCK, RANDY (BS-HIS)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:BLOCK
Suffix:
Gender:M
Credentials:BS-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 N COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1603
Mailing Address - Country:US
Mailing Address - Phone:520-327-0882
Mailing Address - Fax:
Practice Address - Street 1:5950 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3904
Practice Address - Country:US
Practice Address - Phone:520-790-9779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ1471237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist