Provider Demographics
NPI:1720500796
Name:PAJARO VALLEY PREVENTION AND STUDENT ASSISTANCE
Entity Type:Organization
Organization Name:PAJARO VALLEY PREVENTION AND STUDENT ASSISTANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NAJERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-728-6476
Mailing Address - Street 1:335 E LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-4826
Mailing Address - Country:US
Mailing Address - Phone:831-728-6445
Mailing Address - Fax:
Practice Address - Street 1:411 E LAKE AVE
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4424
Practice Address - Country:US
Practice Address - Phone:831-728-6445
Practice Address - Fax:831-761-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1677797251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health