Provider Demographics
NPI:1356540587
Name:SALUD PARA LA GENTE
Entity type:Organization
Organization Name:SALUD PARA LA GENTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DORI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE INDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-728-8250
Mailing Address - Street 1:195 AVIATION WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2053
Mailing Address - Country:US
Mailing Address - Phone:831-728-8250
Mailing Address - Fax:831-786-9865
Practice Address - Street 1:302 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-5524
Practice Address - Country:US
Practice Address - Phone:831-728-8250
Practice Address - Fax:831-728-0313
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALUD PARA LA GENTE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-17
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000001261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC71073FMedicaid
CA551064Medicare Oscar/Certification