Organization
BASKERVILLE, BENNETT, BLOCK & LIU, A MEDICAL CORP
Active
Other names
Capitola Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES BENNETT M.D. (OWNER)
(831) 763-4310
Entity
Organization
Contact information
Practice address
252 GREEN VALLEY RD, FREEDOM, CA 95019-3138
(831) 475-7442
(831) 475-7417
Mailing address
4145 CLARES ST, SUITE A, CAPITOLA, CA 95010-2053
(831) 475-7442
(831) 475-7417
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0099150
—
CA
01
—
ZZZ08030Z
BLUE SHIELD ID#-WV OFFICE
CA
Enumeration date
03/20/2007
Last updated
08/22/2020
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