Provider Demographics
NPI:1134388093
Name:PAJARO VALLEY COMMUNITY HEALTH TRUST
Entity type:Organization
Organization Name:PAJARO VALLEY COMMUNITY HEALTH TRUST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:LAUREN
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED DIETITIAN
Authorized Official - Phone:831-763-6445
Mailing Address - Street 1:85 NIELSON ST
Mailing Address - Street 2:STE 201
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2485
Mailing Address - Country:US
Mailing Address - Phone:831-763-6445
Mailing Address - Fax:831-724-0877
Practice Address - Street 1:85 NIELSON ST
Practice Address - Street 2:STE 201
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2485
Practice Address - Country:US
Practice Address - Phone:831-763-6445
Practice Address - Fax:831-724-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1447327804261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health