Provider Demographics
NPI:1952479966
Name:BLOCK-KURBISCH, INGRID JULIANA (MD)
Entity Type:Individual
Prefix:DR
First Name:INGRID
Middle Name:JULIANA
Last Name:BLOCK-KURBISCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 STANYAN STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1079
Mailing Address - Country:US
Mailing Address - Phone:415-750-5890
Mailing Address - Fax:415-750-5619
Practice Address - Street 1:450 STANYAN STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1079
Practice Address - Country:US
Practice Address - Phone:415-750-5890
Practice Address - Fax:415-750-5619
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49578174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABB2921612OtherDEA NUMBER
CABB2921612OtherDEA NUMBER
CA00A95780Medicare PIN