Provider Demographics
NPI:1679509798
Name:PAJARO VALLEY MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:PAJARO VALLEY MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:O'GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-786-8595
Mailing Address - Street 1:65 NIELSON ST
Mailing Address - Street 2:STE 104
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2491
Mailing Address - Country:US
Mailing Address - Phone:831-786-8595
Mailing Address - Fax:831-786-8557
Practice Address - Street 1:65 NIELSON ST
Practice Address - Street 2:STE 104
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2491
Practice Address - Country:US
Practice Address - Phone:831-786-8595
Practice Address - Fax:831-786-8557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ03561ZMedicare ID - Type UnspecifiedGROUP PROVIDER ID