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General NPI Number Information
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NPI Number | 1962607333
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Entity Type | Organization
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Legal Business Name | CABRILLO COLLEGE
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6500 SOQUEL DR
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City | APTOS
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State | CA
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Zip | 95003-3119
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Country | US
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Telephone | 831-479-6431
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Fax |
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Provider Business Mailing Address
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Address Line | 6500 SOQUEL DR
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City | APTOS
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State | CA
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Zip | 95003-3119
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Country | US
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Telephone | 831-479-6431
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Fax |
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Authorized Official
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Title or Position | PROGRAM CHAIR
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Name | DR. BRIDGETE H CLARK
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Credential |
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Telephone | 831-479-6431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 22173
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License Number State | CA
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