Provider Demographics
NPI:1700142544
Name:SALUD PARA LA GENTE
Entity Type:Organization
Organization Name:SALUD PARA LA GENTE
Other - Org Name:SEASIDE COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O
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:831-707-2777
Practice Address - Street 1:1130 FREMONT BLVD
Practice Address - Street 2:SUITE 210-B
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-5700
Practice Address - Country:US
Practice Address - Phone:831-728-8250
Practice Address - Fax:831-707-2777
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALUD PARA GENTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-05
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA751109Medicare Oscar/Certification