Healthcare Provider Details

I. General information

NPI: 1730388943
Provider Name (Legal Business Name): SALUD PARA LA GENTE-ELDERDAY SANTA CRUZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 10/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PIONEER ST STE C
SANTA CRUZ CA
95060-2181
US

IV. Provider business mailing address

195 AVIATION WAY STE 200
WATSONVILLE CA
95076-2059
US

V. Phone/Fax

Practice location:
  • Phone: 831-763-3414
  • Fax: 831-728-0313
Mailing address:
  • Phone: 831-728-8250
  • Fax: 831-728-8266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number070000178
License Number StateCA

VIII. Authorized Official

Name: ILIANA CUADROS
Title or Position: ACCOUNTING CLERK III
Credential:
Phone: 831-763-3414