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General NPI Number Information
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NPI Number | 1427326859
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Entity Type | Organization
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Legal Business Name | MONTEREY BAY GASTROENTEROLOGY, PC
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | 1505 SOQUEL DR SUITE 12
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City | SANTA CRUZ
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State | CA
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Zip | 95065-1716
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Country | US
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Telephone | 831-713-5050
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Fax | 831-475-0101
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Provider Business Mailing Address
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Address Line | 1505 SOQUEL DR SUITE 12
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City | SANTA CRUZ
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State | CA
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Zip | 95065-1716
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Country | US
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Telephone | 831-713-5050
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Fax | 831-475-0101
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | MR. JUSTIN BENNET
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Credential | M.D.
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Telephone | 831-713-5050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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