Healthcare Provider Details

I. General information

NPI: 1306025754
Provider Name (Legal Business Name): NATIVIDAD MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD STE 101
SALINAS CA
93906-3196
US

IV. Provider business mailing address

PO BOX 80007
SALINAS CA
93912-0007
US

V. Phone/Fax

Practice location:
  • Phone: 831-759-0674
  • Fax: 831-755-4087
Mailing address:
  • Phone: 831-755-4111
  • Fax: 831-755-4087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: VINCE J.L. CARR
Title or Position: BUSINESS OFFICE DIRECTOR
Credential:
Phone: 831-755-4111