Healthcare Provider Details

I. General information

NPI: 1700098969
Provider Name (Legal Business Name): COMMUNITY BRIDGES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 06/03/2023
Certification Date: 06/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 OHLONE PARKWAY
WATSONVILLE CA
95076-6685
US

IV. Provider business mailing address

519 MAIN STREET
WATSONVILLE CA
95076-4356
US

V. Phone/Fax

Practice location:
  • Phone: 831-688-9663
  • Fax: 831-688-8302
Mailing address:
  • Phone: 831-688-8840
  • Fax: 831-688-8302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYMON CANCINO
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 831-688-8840