Provider Demographics
NPI:1710039573
Name:HARBOR MEDICAL GROUP INC
Entity Type:Organization
Organization Name:HARBOR MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:L
Authorized Official - Last Name:PIUMARTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-476-7676
Mailing Address - Street 1:1661 SOQUEL DR
Mailing Address - Street 2:BLDG A
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1709
Mailing Address - Country:US
Mailing Address - Phone:831-476-7676
Mailing Address - Fax:831-476-4824
Practice Address - Street 1:1661 SOQUEL DR
Practice Address - Street 2:BUILDING A
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1709
Practice Address - Country:US
Practice Address - Phone:831-476-7676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ45000ZMedicaid