Healthcare Provider Details

I. General information

NPI: 1295578557
Provider Name (Legal Business Name): COMMUNITY BRIDGES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 06/14/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 CAPITOLA ROAD
SANTA CRUZ CA
95062-3024
US

IV. Provider business mailing address

519 MAIN STREET
WATSONVILLE CA
95076-4356
US

V. Phone/Fax

Practice location:
  • Phone: 831-464-3180
  • Fax: 831-464-1633
Mailing address:
  • Phone: 831-688-8840
  • Fax: 831-688-8302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYMOM CANCINO
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 831-688-8840