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302 Riverside Ave Santa Cruz CA 95060-5524 | |
| (831) 728-8250 | |
| (831) 728-0313 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 302 Riverside Ave, Santa Cruz, California |
| Authorized Official Name and Position | Dori Rose Inda (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8317288250 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
195 Aviation Way Suite 200 Watsonville CA 95076-2053 Ph: (831) 728-8250 | 302 Riverside Ave Santa Cruz CA 95060-5524 Ph: (831) 728-8250 |
| NPI Number | 1356540587 |
|---|---|
| Provider Enumeration Date | 07/17/2007 |
| Last Update Date | 09/05/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356540587 | NPI | - | NPPES |
| FHC71073F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 550000001 (California) | Primary |
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