Provider Demographics
NPI:1962623520
Name:BLOCK, STEVEN MARK (DPM)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MARK
Last Name:BLOCK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:P.O. BOX 11385
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90295-7385
Mailing Address - Country:US
Mailing Address - Phone:818-438-2313
Mailing Address - Fax:310-822-5225
Practice Address - Street 1:13428 MAXELLA AVENUE
Practice Address - Street 2:UNIT 154
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5620
Practice Address - Country:US
Practice Address - Phone:818-438-2313
Practice Address - Fax:310-822-5225
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE1499213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE1499CMedicare ID - Type UnspecifiedMEDICARE I.D.