Healthcare Provider Details

I. General information

NPI: 1851493761
Provider Name (Legal Business Name): STEPHEN J HALPERN & JACK WATSON MDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550A WATER ST
SANTA CRUZ CA
95060
US

IV. Provider business mailing address

550A WATER ST
SANTA CRUZ CA
95060
US

V. Phone/Fax

Practice location:
  • Phone: 831-425-0420
  • Fax: 831-425-0185
Mailing address:
  • Phone: 831-425-0420
  • Fax: 831-425-0185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA65310
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A8853
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberA88228
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA22837
License Number StateCA

VIII. Authorized Official

Name: STEPHEN J HALPERN
Title or Position: OWNER
Credential:
Phone: 831-425-0420