MEDICARE: MONTEREY COUNTY HEALTH DEPARTMENT LABORATORY

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	291U00000X	Clinical Medical Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CACPH0904	OTHER	CA	CALIFORNIA ID

General Provider Information

NPI Number	:	1326125337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTEREY COUNTY HEALTH DEPARTMENT LABORATORY

Provider Business Mailing Address
First Line	:	1270 NATIVIDAD RD
Second Line	:
City	:	SALINAS
State	:	CA
Zip	:	93906-3122
Country	:	US
Telephone Number	:	831-755-4516
Fax Number	:	831-755-4652

Provider Business Practice Location Address
First Line	:	1270 NATIVIDAD RD
Second Line	:
City	:	SALINAS
State	:	CA
Zip	:	93906-3122
Country	:	US
Telephone Number	:	831-755-4516
Fax Number	:	831-755-4652

Authorized Official
Title or Position	:	LABORATORY DIRECTOR
Name	:	MR. GERRY R. GUIBERT
Credential	:	M.S.
Telephone Number	:	831-755-4516

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/30/2010

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