Provider Demographics
NPI:1922889583
Name:MUSKATBLIT, MARK ABRAHAM
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ABRAHAM
Last Name:MUSKATBLIT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 ROACHE RD
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:CA
Mailing Address - Zip Code:95019-2817
Mailing Address - Country:US
Mailing Address - Phone:415-314-5765
Mailing Address - Fax:
Practice Address - Street 1:102 WHEELOCK RD
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-9719
Practice Address - Country:US
Practice Address - Phone:831-768-0941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker