1770709149 NPI number — COUNTY OF 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 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:
Provider Other Organization Name Type Code:
6
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: 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" .
  • 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" .

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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