Provider Demographics
NPI:1740329515
Name:COUNTY OF SANTA CRUZ
Entity type:Organization
Organization Name:COUNTY OF SANTA CRUZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF CLINICS
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-454-4764
Mailing Address - Street 1:1080 EMELINE AVE
Mailing Address - Street 2:LABORATORY
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060
Mailing Address - Country:US
Mailing Address - Phone:831-454-5445
Mailing Address - Fax:831-454-5000
Practice Address - Street 1:1080 EMELINE AVE
Practice Address - Street 2:LABORATORY
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060
Practice Address - Country:US
Practice Address - Phone:831-454-5445
Practice Address - Fax:831-454-5000
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SANTA CRUZ
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-06
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01284F291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAP70042FOtherCA. FAMILY PLANNING
05D0063277OtherCMSCLIA
CALAB01284FMedicaid
CAZZZ59201ZMedicare PIN