Healthcare Provider Details

I. General information

NPI: 1790799047
Provider Name (Legal Business Name): WATSONVILLE SURGEONS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 GREEN VALLEY RD SUITE 101
FREEDOM CA
95019-3160
US

IV. Provider business mailing address

160 GREEN VALLEY RD SUITE 101
FREEDOM CA
95019-3160
US

V. Phone/Fax

Practice location:
  • Phone: 831-763-9700
  • Fax: 831-763-9799
Mailing address:
  • Phone: 831-763-9700
  • Fax: 831-763-9799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number070000651
License Number StateCA

VIII. Authorized Official

Name: PATRICK SEUBERT HALEY
Title or Position: TREASURER
Credential:
Phone: 831-462-5512