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610 Frederick St 3rd Floor Santa Cruz CA 95062-2203 | |
| (831) 462-7501 | |
| (831) 462-7555 |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 610 Frederick St, Santa Cruz, California |
| Authorized Official Name and Position | Michael Walsh (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 8314627504 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1555 Soquel Dr Attn Hospital President Santa Cruz CA 95065-1705 Ph: (831) 462-7501 | 610 Frederick St 3rd Floor Santa Cruz CA 95062-2203 Ph: (831) 462-7501 |
| NPI Number | 1770794265 |
|---|---|
| Provider Enumeration Date | 05/25/2007 |
| Last Update Date | 03/27/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770794265 | NPI | - | NPPES |
| HSP40242G | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 070000030 (California) | Primary |
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