Provider Demographics
NPI:1427326859
Name:MONTEREY BAY GASTROENTEROLOGY, PC
Entity type:Organization
Organization Name:MONTEREY BAY GASTROENTEROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-713-5050
Mailing Address - Street 1:1505 SOQUEL DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1716
Mailing Address - Country:US
Mailing Address - Phone:831-713-5050
Mailing Address - Fax:831-475-0101
Practice Address - Street 1:1505 SOQUEL DR
Practice Address - Street 2:SUITE 12
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1716
Practice Address - Country:US
Practice Address - Phone:831-713-5050
Practice Address - Fax:831-475-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty