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General NPI Number Information
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NPI Number | 1588921761
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Entity Type | Organization
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Legal Business Name | HEALTHSTAT ON-SITE CLINIC/REITER WATSONVILLE
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Dates
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Enumeration Date | 04/12/2012
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Last Update Date | 11/22/2022
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Provider Practice Location Address
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Address Line | 150 CARNATION DR STE 5
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City | FREEDOM
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State | CA
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Zip | 95019-3132
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Country | US
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Telephone | 831-768-0412
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Fax |
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Provider Business Mailing Address
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Address Line | 4601 CHARLOTTE PARK DR SUITE 390
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City | CHARLOTTE
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State | NC
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Zip | 28217-1915
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF RISK MANAGEMENT
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Name | JILL JOHNSON PATTON
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Credential |
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Telephone | 704-936-5546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number |
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License Number State |
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