Basic Information
| Provider Information | |||||||||
| NPI: | 1225098189 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLOCK | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | HOWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8599 HAVEN AVE. | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | RANCHO CUCAMONGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917304849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096208180 | ||||||||
| FaxNumber: | 8667359647 | ||||||||
| Practice Location | |||||||||
| Address1: | 8599 HAVEN AVE. | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | RANCHO CUCAMONGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917304849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096208180 | ||||||||
| FaxNumber: | 8667359647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 03/27/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | G44323 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085U0001X | G44323 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound |
ID Information
| ID | Type | State | Issuer | Description | G44323 | 01 | CA | LICENSE | OTHER | CG1263 | 01 | CA | RAILROAD MEDICARE | OTHER | 00G443230 | 05 | CA | MEDICAID |