Provider Demographics
NPI:1073531513
Name:SANTA CRUZ PULMONARY MEDICAL GROUP
Entity Type:Organization
Organization Name:SANTA CRUZ PULMONARY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:AUDREY
Authorized Official - Last Name:ANYANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-425-1906
Mailing Address - Street 1:700 FREDERICK ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2239
Mailing Address - Country:US
Mailing Address - Phone:831-425-1906
Mailing Address - Fax:831-425-1922
Practice Address - Street 1:700 FREDERICK ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2239
Practice Address - Country:US
Practice Address - Phone:831-425-1906
Practice Address - Fax:831-425-1922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0056730Medicaid
ZZZ37105ZMedicare ID - Type Unspecified