=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013388974
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SALUD PARA LA GENTE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2015
-----------------------------------------------------
Last Update Date | 10/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 195 AVIATION WAY, SUITE 200
-----------------------------------------------------
City | WATSONVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-728-8250
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 195 AVIATION WAY, SUITE 200
-----------------------------------------------------
City | WATSONVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-728-8250
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CMO
-----------------------------------------------------
Name | DR. AMY MCENTEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 831-728-8250
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Clinic/Center
-----------------------------------------------------
License Number | 95003025
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------