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3155 De Forest Rd. Marina CA 93933-2702 | |
(831) 384-1445 | |
(831) 384-1454 |
Full Name | |
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Speciality | Family Medicine |
Location | 3155 De Forest Rd., Marina, California |
Authorized Official Name and Position | Julia Claire Edgcomb (DIRECTOR/COO CLINIC SERVICES DIV.) |
Authorized Official Contact | 8317961386 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1441 Schilling Place South Bldg Floor 1 Salinas CA 93901-4527 Ph: (831) 796-1308 | 3155 De Forest Rd. Marina CA 93933-2702 Ph: (831) 384-1445 |
NPI Number | 1588617955 |
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Provider Enumeration Date | 05/18/2006 |
Last Update Date | 06/16/2017 |
Medicare PECOS PAC ID | 2466345632 |
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Medicare Enrollment ID | O20091016000243 |
Identifier | Type | State | Issuer |
---|---|---|---|
1588617955 | NPI | - | NPPES |
HAP70655F | Medicaid | CA | |
BCP70655F | Medicaid | CA | |
BCP70530F | Other | CA | BCEDP |
FHC70655F | Medicaid | CA | |
ZZZ02040Z | Other | CA | PTAN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Dunecrest Medical Group Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 232 Reservation Rd, Marina, CA 93933 Phone: 831-384-0662 Fax: 831-384-0754 | |