Healthcare Provider Details

I. General information

NPI: 1821215708
Provider Name (Legal Business Name): MICHAEL D LABINGER CCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 TIE GULCH RD
SANTA CRUZ CA
95065-9626
US

IV. Provider business mailing address

140 TIE GULCH RD
SANTA CRUZ CA
95065-9626
US

V. Phone/Fax

Practice location:
  • Phone: 831-426-4606
  • Fax: 650-615-9995
Mailing address:
  • Phone: 831-426-4606
  • Fax: 650-615-9995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number810011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: