Provider Demographics
NPI:1184276693
Name:BLOCKER, ROBBIN T
Entity type:Individual
Prefix:
First Name:ROBBIN
Middle Name:T
Last Name:BLOCKER
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 1:8001 MIDCROWN DR STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-2317
Mailing Address - Country:US
Mailing Address - Phone:210-337-3640
Mailing Address - Fax:210-337-5617
Practice Address - Street 1:8001 MIDCROWN DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-2316
Practice Address - Country:US
Practice Address - Phone:210-337-3640
Practice Address - Fax:210-337-5617
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX148986261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX464963797Medicaid