Basic Information
| Provider Information | |||||||||
| NPI: | 1063151363 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COUNTY OF MONTEREY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 80007 | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939120007 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 17615 MORO RD | ||||||||
| Address2: | |||||||||
| City: | PRUNEDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939078541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316633926 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2022 | ||||||||
| LastUpdateDate: | 06/03/2022 | ||||||||
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| AuthorizedOfficialLastName: | SHORT | ||||||||
| AuthorizedOfficialFirstName: | TRACY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR PATIENT FINANCIAL SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 8317832347 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COUNTY OF MONTEREY | ||||||||
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| NPICertificationDate: | 05/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.