Provider Demographics
NPI:1063551976
Name:COUNTY OF SANTA CRUZ
Entity type:Organization
Organization Name:COUNTY OF SANTA CRUZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF CLINICS
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-454-4764
Mailing Address - Street 1:1430 FREEDOM BLVD
Mailing Address - Street 2:LABORATORY
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2780
Mailing Address - Country:US
Mailing Address - Phone:831-763-8173
Mailing Address - Fax:831-763-8237
Practice Address - Street 1:1430 FREEDOM BLVD
Practice Address - Street 2:LABORATORY
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2780
Practice Address - Country:US
Practice Address - Phone:831-763-8173
Practice Address - Fax:831-763-8237
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE COUNTY OF SANTA CRUZ
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-06
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA04130F291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
05D0875212OtherCMS CLIA
CAHAP70044FOtherCA. FAMILY PLANNING
CALAB04130FMedicaid
CAZZZ95051ZOtherMEDICARE PTAN
CABQ985OtherMEDICARE PTAN
CACA154566OtherMEDICARE PTAN