1730388943 NPI number — SALUD PARA LA GENTE-ELDERDAY SANTA CRUZ

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730388943 NPI number — SALUD PARA LA GENTE-ELDERDAY SANTA CRUZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SALUD PARA LA GENTE-ELDERDAY 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:
Provider Other Organization Name Type Code:
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:
1730388943
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
195 AVIATION WAY STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATSONVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95076-2059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-728-8250
Provider Business Mailing Address Fax Number:
831-728-8266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 PIONEER ST STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA CRUZ
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95060-2181
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-763-3414
Provider Business Practice Location Address Fax Number:
831-728-0313
Provider Enumeration Date:
07/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CUADROS
Authorized Official First Name:
ILIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNTING CLERK III
Authorized Official Telephone Number:
831-763-3414

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  070000178 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ADUF0028G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".