Healthcare Provider Details

I. General information

NPI: 1568415495
Provider Name (Legal Business Name): PLANNED PARENTHOOD MAR MONTE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 COTTONWOOD ST SUITE 10
WOODLAND CA
95695-3603
US

IV. Provider business mailing address

1691 THE ALAMEDA
SAN JOSE CA
95126-2203
US

V. Phone/Fax

Practice location:
  • Phone: 530-662-4646
  • Fax: 530-662-4235
Mailing address:
  • Phone: 408-795-3600
  • Fax: 408-971-6935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number030000411
License Number StateCA

VIII. Authorized Official

Name: MR. TOM MOTSIFF
Title or Position: CFO
Credential: MHA, CMA
Phone: 408-795-3707