Provider Demographics
NPI:1790027498
Name:SCOTTS VALLEY VETERINARY CLINIC, INC.
Entity Type:Organization
Organization Name:SCOTTS VALLEY VETERINARY CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DVM
Authorized Official - Phone:831-438-2600
Mailing Address - Street 1:4257 SCOTTS VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-4521
Mailing Address - Country:US
Mailing Address - Phone:831-438-2600
Mailing Address - Fax:831-438-0169
Practice Address - Street 1:4257 SCOTTS VALLEY DR
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-4521
Practice Address - Country:US
Practice Address - Phone:831-438-2600
Practice Address - Fax:831-438-0169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVET6932174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174M00000XOther Service ProvidersVeterinarianGroup - Single Specialty