Provider Demographics
NPI:1588617955
Name:COUNTY OF MONTEREY
Entity Type:Organization
Organization Name:COUNTY OF MONTEREY
Other - Org Name:MONTEREY COUNTY HEALTH CLINIC AT MARINA
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 1:3155 DE FOREST RD.
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-2702
Practice Address - Country:US
Practice Address - Phone:831-384-1445
Practice Address - Fax:831-384-1454
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTEREY COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-18
Last Update Date:2017-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAP70655FMedicaid
CABCP70655FMedicaid
CABCP70530FOtherBCEDP
CAFHC70655FMedicaid
CAZZZ02040ZOtherPTAN