Healthcare Provider Details

I. General information

NPI: 1659732097
Provider Name (Legal Business Name): DANIEL EZEKIEL CONTRERAS SUDCC III-CS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DANNY CONTRERAS CADC-CAS

II. Dates (important events)

Enumeration Date: 03/13/2016
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 FREEDOM BLVD
WATSONVILLE CA
95076-2780
US

IV. Provider business mailing address

PO BOX 962
SANTA CRUZ CA
95061
US

V. Phone/Fax

Practice location:
  • Phone: 831-763-8400
  • Fax:
Mailing address:
  • Phone: 831-454-4100
  • Fax: 831-454-4296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number9263
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: