Basic Information
| Provider Information | |||||||||
| NPI: | 1457489122 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COUNTY OF MONTEREY | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | LAUREL FAMILY PRACTICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1441 SCHILLING PLACE | ||||||||
| Address2: | SOUTH BLDG - FIRST FLOOR - HEALTH DEPT CLINIC SERVICES | ||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939014527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317698800 | ||||||||
| FaxNumber: | 8314229312 | ||||||||
| Practice Location | |||||||||
| Address1: | 1441 CONSTITUTION BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939063134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317554123 | ||||||||
| FaxNumber: | 8317554122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | EDGCOMB | ||||||||
| AuthorizedOfficialFirstName: | JULIA | ||||||||
| AuthorizedOfficialMiddleName: | CLAIRE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR/COO CLINIC SERVICES DIV | ||||||||
| AuthorizedOfficialTelephone: | 8317696522 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MONTEREY COUNTY HEALTH DEPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | FHC70127F | 05 | CA | MEDICAID | HAP70127F | 01 | CA | COUNTY OF MONTEREY FAMPAC | OTHER |