MEDICARE: SANTA CRUZ PULMONARY MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician

General Provider Information

NPI Number	:	1073531513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA CRUZ PULMONARY MEDICAL GROUP

Provider Business Mailing Address
First Line	:	700 FREDERICK ST
Second Line	:	SUITE 203
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-2239
Country	:	US
Telephone Number	:	831-425-1906
Fax Number	:	831-425-1922

Provider Business Practice Location Address
First Line	:	700 FREDERICK ST
Second Line	:	SUITE 203
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-2239
Country	:	US
Telephone Number	:	831-425-1906
Fax Number	:	831-425-1922

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MRS. REGINA AUDREY ANYANG
Credential	:
Telephone Number	:	831-425-1906

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	02/17/2010

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