Basic Information
| Provider Information | |||||||||
| NPI: | 1306025754 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NATIVIDAD MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 80007 | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939120007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317554111 | ||||||||
| FaxNumber: | 8317554087 | ||||||||
| Practice Location | |||||||||
| Address1: | 1441 CONSTITUTION BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939063196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317590674 | ||||||||
| FaxNumber: | 8317554087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2007 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | CARR | ||||||||
| AuthorizedOfficialFirstName: | VINCE | ||||||||
| AuthorizedOfficialMiddleName: | J.L. | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS OFFICE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8317554111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.