Provider Demographics
NPI:1790525467
Name:ROCK, MARK STEVEN
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:STEVEN
Last Name:ROCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49713 GORMAN POST RD
Mailing Address - Street 2:
Mailing Address - City:GORMAN
Mailing Address - State:CA
Mailing Address - Zip Code:93243-9701
Mailing Address - Country:US
Mailing Address - Phone:866-402-8801
Mailing Address - Fax:
Practice Address - Street 1:6532 PARKER DR
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1902
Practice Address - Country:US
Practice Address - Phone:661-582-9749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty