Baskerville, Bennett, Block & Liu, a Medical Corp
Organization Active NPI Pediatrics Physician · Freedom, CA
NPI 1962527606 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1962527606
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- BASKERVILLE, BENNETT, BLOCK & LIU, A MEDICAL CORP
- Practice address
- 252 Green Valley Rd
Freedom, CA 95019-3138 - Phone
- (831) 475-7442
- Fax
- (831) 475-7417
- NPI assigned
- Mar 20, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. James Bennett, M.D.
- Title
- Owner
- Phone
- (831) 763-4310
Corporate family (same tax ID) 1
National Provider Directory
- Tax ID family
- Baskerville Bennett Block Liu a Medical Corp
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | Yes |
Addresses
Primary practice location
252 Green Valley Rd
Freedom, CA 95019-3138
Mailing address
4145 Clares St
Suite a
Capitola, CA 95010-2053
Phone (831) 475-7442
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ08030Z | Other | CA | BLUE SHIELD ID#-WV OFFICE |
| GR0099150 | Medicaid | CA |
Other names
- Capitola Pediatrics
Other providers in Freedom, CA
- Ali Alhomaidi
- Caroline Anaya
- Efrain Armenta
- Luz M Avila
- Barker Seftel Spilman Gen PTRS
- Lawrence A Birndorf
- Edward Bradbury
- Jose Bugay
- George Pardue Bunch
- Central Coast Endoscopy Center Inc
All providers in Freedom, CA · Pediatrics Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.