=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063151363
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF MONTEREY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2022
-----------------------------------------------------
Last Update Date | 06/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17615 MORO RD
-----------------------------------------------------
City | PRUNEDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93907-8541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-663-3926
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 80007
-----------------------------------------------------
City | SALINAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93912-0007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR PATIENT FINANCIAL SERVICES
-----------------------------------------------------
Name | TRACY SHORT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 831-783-2347
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------