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General NPI Number Information
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NPI Number | 1336824085
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Entity Type | Organization
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Legal Business Name | THE CIRCLE FAMILY CENTER
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Dates
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Enumeration Date | 06/20/2023
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Last Update Date | 06/20/2023
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Provider Practice Location Address
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Address Line | 245 SEA RIDGE RD
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City | APTOS
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State | CA
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Zip | 95003-4364
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Country | US
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Telephone | 831-645-1150
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Fax |
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Provider Business Mailing Address
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Address Line | 245 SEA RIDGE RD
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City | APTOS
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State | CA
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Zip | 95003-4364
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Country | US
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Telephone | 831-645-1150
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ELISA RENEE HAVENS-STOKES
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Credential |
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Telephone | 831-645-1151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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