Healthcare Provider Details

I. General information

NPI: 1720807142
Provider Name (Legal Business Name): WALNUT AVENUE FAMILY & WOMEN'S CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 WALNUT AVE
SANTA CRUZ CA
95060-3659
US

IV. Provider business mailing address

303 WALNUT AVE
SANTA CRUZ CA
95060-3659
US

V. Phone/Fax

Practice location:
  • Phone: 831-426-3062
  • Fax:
Mailing address:
  • Phone: 831-426-3062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. JULIE P. MACECEVIC
Title or Position: EXECUTIVE DIRECTOR
Credential: PSY23881
Phone: 831-426-3062