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2901 Park Ave # B8 Soquel CA 95073-2831 | |
| (831) 471-5044 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2901 Park Ave # B8, Soquel, California |
| Authorized Official Name and Position | David Alan Resnikoff (OWNER) |
| Authorized Official Contact | 8314715044 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 514 Santa Cruz CA 95061-0514 Ph: (831) 471-5044 | 2901 Park Ave # B8 Soquel CA 95073-2831 Ph: (831) 471-5044 |
| NPI Number | 1194376830 |
|---|---|
| Provider Enumeration Date | 09/24/2019 |
| Last Update Date | 01/03/2020 |
| Certification Date | 01/03/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194376830 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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