Organization
SURGICAL ASSOCIATES OF MONTEREY BAY MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER SHOUP (ADMINISTRATIVE ASSISTANT)
(831) 464-9962
Entity
Organization
Contact information
Practice address
1668 DOMINICAN WAY, SANTA CRUZ, CA 95065-1522
(831) 464-9962
(831) 464-9933
Mailing address
1668 DOMINICAN WAY, SANTA CRUZ, CA 95065-1522
(831) 464-9962
(831) 464-9933
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
2086S0129X
Vascular Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0100250
—
CA
Enumeration date
11/06/2006
Last updated
08/07/2013
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