Organization · NPI-2

1150 Main Street INC

Family Medicine · Watsonville, CA

NPI number1912347261
StatusActive
Last updated in NPPESJul 1, 2013

Details

NPI
1912347261
Entity type
Organization (NPI-2)
Legal business name
1150 Main Street INC
Organization subpart
No
Enumeration date
Jul 1, 2013
Last updated
Jul 1, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family MedicineG56281CAYes

Practice location

1150 Main St Ste 3
Watsonville, CA 95076-3760

Phone 831-728-0551 · Fax 831-728-3679

Mailing address

1150 Main St Ste 3
Watsonville, CA 95076-3760

Phone 831-728-0551 · Fax 831-728-3679

Authorized official

Shirley L Dickinson
Manager
8317280551

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