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1595 Soquel Dr Ste 400 Santa Cruz CA 95065-1724 | |
| (831) 475-1111 | |
| (831) 476-5020 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 1595 Soquel Dr Ste 400, Santa Cruz, California |
| Authorized Official Name and Position | Theresa M Hylen (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 9168512559 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 742513 Los Angeles CA 90074-2513 Ph: (916) 733-5701 | 1595 Soquel Dr Ste 400 Santa Cruz CA 95065-1724 Ph: (831) 475-1111 |
| NPI Number | 1598961245 |
|---|---|
| Provider Enumeration Date | 06/21/2007 |
| Last Update Date | 11/18/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598961245 | NPI | - | NPPES |
| GR0091684 | Medicaid | CA | |
| ZZZ50291Z | Other | BSCA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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