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301 The Alameda Suite B3 San Juan Bautista CA 95045-9746 | |
(831) 623-4615 | |
(831) 623-4689 |
Full Name | |
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Speciality | Clinic/Center |
Location | 301 The Alameda, San Juan Bautista, California |
Authorized Official Name and Position | Mary Casillas (CEO) |
Authorized Official Contact | 8316362604 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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911 Sunset Dr Hollister CA 95023-5602 Ph: (831) 637-5711 | 301 The Alameda Suite B3 San Juan Bautista CA 95045-9746 Ph: (831) 623-4615 |
NPI Number | 1891811907 |
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Provider Enumeration Date | 03/21/2007 |
Last Update Date | 01/11/2024 |
Medicare PECOS PAC ID | 9133038326 |
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Medicare Enrollment ID | O20030321000062 |
Identifier | Type | State | Issuer |
---|---|---|---|
1891811907 | NPI | - | NPPES |
RHM08590F | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 070000004 (California) | Primary |