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305 Marion Ave Ben Lomond CA 95005-9403 | |
(831) 429-8350 | |
Not Available |
Full Name | |
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Speciality | Community/behavioral Health |
Location | 305 Marion Ave, Ben Lomond, California |
Authorized Official Name and Position | Carol Pruitt (PROGRAM MANAGER) |
Authorized Official Contact | 8314298350 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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709 Mission St Santa Cruz CA 95060-3614 Ph: () - | 305 Marion Ave Ben Lomond CA 95005-9403 Ph: (831) 429-8350 |
NPI Number | 1760670806 |
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Provider Enumeration Date | 10/12/2007 |
Last Update Date | 10/12/2007 |
Identifier | Type | State | Issuer |
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1760670806 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |