Basic Information
| Provider Information | |||||||||
| NPI: | 1548398217 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COUNTY OF MONTEREY | ||||||||
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| OtherOrganizationName: | LAUREL WOMEN'S HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1615 BUNKER HILL WAY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939066010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317698800 | ||||||||
| FaxNumber: | 8314229312 | ||||||||
| Practice Location | |||||||||
| Address1: | 1441 CONSTITUTION BLVD | ||||||||
| Address2: | BLDG. 200, SUITE 105 | ||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939063100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317698660 | ||||||||
| FaxNumber: | 8317698655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 09/11/2009 | ||||||||
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| AuthorizedOfficialLastName: | EDGCOMB | ||||||||
| AuthorizedOfficialFirstName: | JULIA | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | COO/DIRECTOR 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 | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | HAP70125F | 01 | CA | COUNTY OF MONTEREY FAMPAC | OTHER | FHC70125F | 05 | CA | MEDICAID |