Provider Demographics
NPI:1629269618
Name:SALUD PARA LA GENTE
Entity Type:Organization
Organization Name:SALUD PARA LA GENTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BALISTRERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-728-8250
Mailing Address - Street 1:PO BOX 1870
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95077-1870
Mailing Address - Country:US
Mailing Address - Phone:831-728-8250
Mailing Address - Fax:831-786-9865
Practice Address - Street 1:45 NIELSON STREET
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076
Practice Address - Country:US
Practice Address - Phone:831-761-1588
Practice Address - Fax:831-761-1677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000469261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70835GMedicaid
CAHAP70835GOtherFAMILY PACT SPECIALTY PRO