Basic Information
| Provider Information | |||||||||
| NPI: | 1407254477 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COUNTY OF MONTEREY | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BIENESTAR KING CITY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1615 BUNKER HILL WAY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939066013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317961386 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 BROADWAY ST | ||||||||
| Address2: | SUITE 70 | ||||||||
| City: | KING CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939302865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317698800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2014 | ||||||||
| LastUpdateDate: | 12/08/2014 | ||||||||
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| AuthorizedOfficialLastName: | EDGCOMB | ||||||||
| AuthorizedOfficialFirstName: | JULIA | ||||||||
| AuthorizedOfficialMiddleName: | CLAIRE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR/COO CLINIC SERVICES BUREAU | ||||||||
| AuthorizedOfficialTelephone: | 8317961386 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MONTEREY COUNTY HEALTH DEPARTMENT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.