Provider Demographics
NPI:1841228848
Name:SANTA CRUZ CAN AM MEDICAL GROUP,INC
Entity Type:Organization
Organization Name:SANTA CRUZ CAN AM MEDICAL GROUP,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:PLETSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-462-1000
Mailing Address - Street 1:223 MOUNT HERMON RD # A
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-4086
Mailing Address - Country:US
Mailing Address - Phone:831-462-1000
Mailing Address - Fax:831-462-9519
Practice Address - Street 1:223 MOUNT HERMON RD # A
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-4086
Practice Address - Country:US
Practice Address - Phone:831-462-1000
Practice Address - Fax:831-462-9519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG99372086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherIRS
CAZZZ74869ZMedicare ID - Type UnspecifiedGROUP LOCATION ONE