Basic Information
| Provider Information | |||||||||
| NPI: | 1720500796 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAJARO VALLEY PREVENTION AND STUDENT ASSISTANCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 335 E LAKE AVE | ||||||||
| Address2: | |||||||||
| City: | WATSONVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950764826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317286445 | ||||||||
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| Practice Location | |||||||||
| Address1: | 411 E LAKE AVE | ||||||||
| Address2: | |||||||||
| City: | WATSONVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950764424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317286445 | ||||||||
| FaxNumber: | 8317616011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2017 | ||||||||
| LastUpdateDate: | 11/01/2022 | ||||||||
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| AuthorizedOfficialLastName: | NAJERA | ||||||||
| AuthorizedOfficialFirstName: | JASMINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8317286476 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | C1677797 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.