Provider Demographics
NPI:1326203233
Name:FAMILY DOCTORS OF SANTA CRUZ A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:FAMILY DOCTORS OF SANTA CRUZ A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HALPERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-425-0420
Mailing Address - Street 1:550 WATER ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4124
Mailing Address - Country:US
Mailing Address - Phone:831-425-0420
Mailing Address - Fax:831-425-7588
Practice Address - Street 1:550 WATER ST
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4124
Practice Address - Country:US
Practice Address - Phone:831-425-0420
Practice Address - Fax:831-425-7018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22837207Q00000X
CAA65310207Q00000X
CA20A8853207Q00000X
CAA91901207Q00000X
CAA98119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty