Provider Demographics
NPI:1265552301
Name:LOS ROBLES CPSP
Entity type:Organization
Organization Name:LOS ROBLES CPSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-496-6613
Mailing Address - Street 1:1534 N MOORPARK RD STE 116
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5129
Mailing Address - Country:US
Mailing Address - Phone:805-373-5707
Mailing Address - Fax:805-495-0711
Practice Address - Street 1:2220 LYNN RD STE 107B
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-8014
Practice Address - Country:US
Practice Address - Phone:805-373-5707
Practice Address - Fax:805-375-0711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGR0064740207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0064740Medicaid