Provider Demographics
NPI:1457303356
Name:COUNTY OF MONTEREY
Entity Type:Organization
Organization Name:COUNTY OF MONTEREY
Other - Org Name:LAUREL PEDIATRIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/COO CLINIC SERVICES DIV.
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:EDGCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-796-1386
Mailing Address - Street 1:1441 SCHILLING PLACE
Mailing Address - Street 2:SOUTH BLDG FLOOR 1
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4527
Mailing Address - Country:US
Mailing Address - Phone:831-796-1308
Mailing Address - Fax:831-757-0291
Practice Address - Street 1:1441 CONSTITUTION BLVD
Practice Address - Street 2:BLDG 200 FLOOR 1, STE 101
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3100
Practice Address - Country:US
Practice Address - Phone:831-755-4124
Practice Address - Fax:831-755-7077
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONETERY COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-17
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAP70126FOtherFAMPACT
CAFHC70126FMedicaid
ZZZ02040ZOtherPTAN