Healthcare Provider Details

I. General information

NPI: 1336369560
Provider Name (Legal Business Name): CLINICA DEL VALLE DEL PAJARO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 NIELSON ST
WATSONVILLE CA
95076
US

IV. Provider business mailing address

PO BOX 1870
WATSONVILLE CA
95077-1870
US

V. Phone/Fax

Practice location:
  • Phone: 831-761-1588
  • Fax: 831-761-1677
Mailing address:
  • Phone: 831-728-8250
  • Fax: 831-707-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number07000469
License Number StateCA

VIII. Authorized Official

Name: GUADALUPE GONZALEZ
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 831-728-8250