Healthcare Provider Details

I. General information

NPI: 1629284609
Provider Name (Legal Business Name): SANTA CRUZ COUNTY CCS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 HERMAN AVE
WATSONVILLE CA
95076-2920
US

IV. Provider business mailing address

1080 EMELINE AVE
SANTA CRUZ CA
95060-1966
US

V. Phone/Fax

Practice location:
  • Phone: 831-688-8400
  • Fax: 831-722-1114
Mailing address:
  • Phone: 831-622-8400
  • Fax: 831-761-6167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRIS DYBDAHL
Title or Position: SENIOR PROGRAM MANAGER
Credential:
Phone: 831-763-8914