Healthcare Provider Details

I. General information

NPI: 1356540587
Provider Name (Legal Business Name): SALUD PARA LA GENTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 RIVERSIDE AVE
SANTA CRUZ CA
95060-5524
US

IV. Provider business mailing address

195 AVIATION WAY SUITE 200
WATSONVILLE CA
95076-2053
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-8250
  • Fax: 831-728-0313
Mailing address:
  • Phone: 831-728-8250
  • Fax: 831-786-9865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number550000001
License Number StateCA

VIII. Authorized Official

Name: DORI ROSE INDA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 831-728-8250