Healthcare Provider Details

I. General information

NPI: 1073780011
Provider Name (Legal Business Name): MONTEREY BAY UROLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 SOQUEL DR
SANTA CRUZ CA
95065-1700
US

IV. Provider business mailing address

160 GREEN VALLEY RD SUITE 203
FREEDOM CA
95019-3160
US

V. Phone/Fax

Practice location:
  • Phone: 831-476-2626
  • Fax: 831-476-3355
Mailing address:
  • Phone: 831-728-4227
  • Fax: 831-728-0410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberG75256 PARTNER
License Number StateCA

VIII. Authorized Official

Name: DAVID STEPHEN BENJAMIN
Title or Position: PARTNER
Credential: MD
Phone: 831-728-4227