Provider Demographics
NPI:1821029414
Name:BROCK, CHRISTINA MARIE (MS)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:BROCK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9350 CAMPUS POINT DR, 2D
Mailing Address - Street 2:#0996
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1300
Mailing Address - Country:US
Mailing Address - Phone:858-657-7216
Mailing Address - Fax:858-657-7201
Practice Address - Street 1:9350 CAMPUS POINT DR, 2D
Practice Address - Street 2:#0996
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92037-1300
Practice Address - Country:US
Practice Address - Phone:858-657-7216
Practice Address - Fax:858-657-7201
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
2005036OtherABGC CERTIFICATE NUMBER