| Paul Luther Md, A Professional Corporation | |
|
1663 Dominican Way Suite 214 Santa Cruz CA 95065-1527 | |
| (831) 809-6766 | |
| Not Available |
| Full Name | Paul Luther Md, A Professional Corporation |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1663 Dominican Way, Santa Cruz, California |
| Authorized Official Name and Position | Paul K Luther (OWNER) |
| Authorized Official Contact | 8318096766 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Paul Luther Md, A Professional Corporation 1663 Dominican Way Suite 214 Santa Cruz CA 95065-1527 Ph: (831) 809-6766 | Paul Luther Md, A Professional Corporation 1663 Dominican Way Suite 214 Santa Cruz CA 95065-1527 Ph: (831) 809-6766 |
| NPI Number | 1174833669 |
|---|---|
| Provider Enumeration Date | 10/18/2010 |
| Last Update Date | 10/18/2010 |
| Medicare PECOS PAC ID | 6103257902 |
|---|---|
| Medicare Enrollment ID | O20200512000278 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174833669 | NPI | - | NPPES |
| 00A307580 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | A030758 (California) | Primary |
| Provider Name | Paul K Luther |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437184660 PECOS PAC ID: 5799721817 Enrollment ID: I20050629000515 |
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