Provider Demographics
NPI:1811254014
Name:SANTA CRUZ-MONTEREY MANAGED MEDICAL
Entity type:Organization
Organization Name:SANTA CRUZ-MONTEREY MANAGED MEDICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER SERVICES RESOLUTION MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-430-5500
Mailing Address - Street 1:1600 GREEN HILLS RD
Mailing Address - Street 2:STE 101
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-4981
Mailing Address - Country:US
Mailing Address - Phone:831-430-5500
Mailing Address - Fax:831-430-5856
Practice Address - Street 1:1600 GREEN HILLS RD
Practice Address - Street 2:STE 101
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-4981
Practice Address - Country:US
Practice Address - Phone:831-430-5500
Practice Address - Fax:831-430-5856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization