Healthcare Provider Details

I. General information

NPI: 1891811907
Provider Name (Legal Business Name): HAZEL HAWKINS MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 THE ALAMEDA SUITE B3
SAN JUAN BAUTISTA CA
95045-9746
US

IV. Provider business mailing address

911 SUNSET DR
HOLLISTER CA
95023-5602
US

V. Phone/Fax

Practice location:
  • Phone: 831-623-4615
  • Fax: 831-623-4689
Mailing address:
  • Phone: 831-637-5711
  • Fax: 831-637-3126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number070000004
License Number StateCA

VIII. Authorized Official

Name: MRS. MARY CASILLAS
Title or Position: CEO
Credential:
Phone: 831-636-2604