Provider Demographics
NPI:1891824074
Name:UNIVERSITY OF CALIFORNIA SANTA CRUZ
Entity Type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA SANTA CRUZ
Other - Org Name:UCSC COWELL STUDENT HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELKIND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-459-2869
Mailing Address - Street 1:1156 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95064-1077
Mailing Address - Country:US
Mailing Address - Phone:831-459-2869
Mailing Address - Fax:831-459-4330
Practice Address - Street 1:1156 HIGH ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95064-1077
Practice Address - Country:US
Practice Address - Phone:831-459-2869
Practice Address - Fax:831-459-4330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health