Healthcare Provider Details

I. General information

NPI: 1770709149
Provider Name (Legal Business Name): COUNTY OF SANTA CRUZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 FREEDOM BLVD.
WATSONVILLE CA
95076
US

IV. Provider business mailing address

1080 EMELINE AVE
SANTA CRUZ CA
95060-1966
US

V. Phone/Fax

Practice location:
  • Phone: 831-763-8400
  • Fax: 831-763-8237
Mailing address:
  • Phone: 831-454-5401
  • Fax: 831-454-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: AMY PEELER
Title or Position: CHIEF OF CLINIC SERVICES
Credential:
Phone: 831-454-4764