Healthcare Provider Details

I. General information

NPI: 1538815253
Provider Name (Legal Business Name): SANTA CRUZ COMMUNITY HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 CENTRAL AVE
BEN LOMOND CA
95005-9349
US

IV. Provider business mailing address

PO BOX 542
SANTA CRUZ CA
95061-0542
US

V. Phone/Fax

Practice location:
  • Phone: 831-427-3500
  • Fax:
Mailing address:
  • Phone: 831-427-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LESLIE CONNER
Title or Position: CHIEF EXECUTIVE DIRECTOR
Credential: MPH
Phone: 831-427-3500