Provider Demographics
NPI:1457489122
Name:COUNTY OF MONTEREY
Entity Type:Organization
Organization Name:COUNTY OF MONTEREY
Other - Org Name:LAUREL FAMILY PRACTICE
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:831-769-6522
Mailing Address - Street 1:1441 SCHILLING PLACE
Mailing Address - Street 2:SOUTH BLDG - FIRST FLOOR - HEALTH DEPT CLINIC SERVICES
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4527
Mailing Address - Country:US
Mailing Address - Phone:831-769-8800
Mailing Address - Fax:831-422-9312
Practice Address - Street 1:1441 CONSTITUTION BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3134
Practice Address - Country:US
Practice Address - Phone:831-755-4123
Practice Address - Fax:831-755-4122
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTEREY COUNTY HEALTH DEPT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70127FMedicaid
CAHAP70127FOtherCOUNTY OF MONTEREY FAMPAC