=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740329515
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF SANTA CRUZ
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2007
-----------------------------------------------------
Last Update Date | 11/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1080 EMELINE AVE LABORATORY
-----------------------------------------------------
City | SANTA CRUZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-454-5445
-----------------------------------------------------
Fax | 831-454-5000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1080 EMELINE AVE LABORATORY
-----------------------------------------------------
City | SANTA CRUZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-454-5445
-----------------------------------------------------
Fax | 831-454-5000
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OF CLINICS
-----------------------------------------------------
Name | MS. AMY PEELER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 831-454-4764
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 01284F
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------