Healthcare Provider Details

I. General information

NPI: 1992849012
Provider Name (Legal Business Name): PUENTES AL SUR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CRESTVIEW DR
WATSONVILLE CA
95076-2723
US

IV. Provider business mailing address

1400 EMELINE AVE
SANTA CRUZ CA
95060-1976
US

V. Phone/Fax

Practice location:
  • Phone: 831-454-5179
  • Fax: 831-454-4663
Mailing address:
  • Phone: 831-454-4170
  • Fax: 831-454-4663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: RAMA KHALSA
Title or Position: HEALTH SERVICES AGENCY DIRECTOR
Credential: PH.D.
Phone: 831-454-4000