Provider Demographics
NPI:1861634859
Name:KNOBLOCH, DENISE MARIE
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:MARIE
Last Name:KNOBLOCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 MORENA BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3815
Mailing Address - Country:US
Mailing Address - Phone:619-692-8703
Mailing Address - Fax:619-542-4969
Practice Address - Street 1:1250 MORENA BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3815
Practice Address - Country:US
Practice Address - Phone:619-692-8703
Practice Address - Fax:619-542-4969
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251B00000X-CASE MANA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA#95-60000934OtherDIRECTOR OF HEALTH & HUMAN SERVICES - SAN DIEGO