Provider Demographics
NPI:1245353465
Name:SUTTER SANTA CRUZ MATERNITY AND SURGERY CENTER
Entity type:Organization
Organization Name:SUTTER SANTA CRUZ MATERNITY AND SURGERY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-458-5595
Mailing Address - Street 1:2880 SOQUEL AVE
Mailing Address - Street 2:SUITE #10
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1423
Mailing Address - Country:US
Mailing Address - Phone:831-475-1501
Mailing Address - Fax:
Practice Address - Street 1:2880 SOQUEL AVE
Practice Address - Street 2:SUITE #10
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-1423
Practice Address - Country:US
Practice Address - Phone:831-475-1501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR07007GMedicaid
CAZZR07007GMedicaid