1770709149 NPI number — COUNTY OF SANTA CRUZ

Table of content: (NPI 1770709149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770709149 NPI number — COUNTY OF SANTA CRUZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF SANTA CRUZ
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WATSONVILLE HEALTH CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770709149
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1080 EMELINE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA CRUZ
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95060-1966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-454-5401
Provider Business Mailing Address Fax Number:
831-454-4488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1430 FREEDOM BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATSONVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-763-8400
Provider Business Practice Location Address Fax Number:
831-763-8237
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PEELER
Authorized Official First Name:
AMY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OF CLINIC SERVICES
Authorized Official Telephone Number:
831-454-4764

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0850X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1659315430 . This is a "LEGAL ENTITY NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: FHC70044F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 261QM0855X . This is a "TAXONOMY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HAP70044F . This is a "STATE OF CA FOR FAMILY PL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: BCP70044F . This is a "CALIF. CANCER DETECTION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 261QM0850X . This is a "TAXONOMY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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