Organization
EASTFIELD MING QUONG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KELLI WILLIAMSON PSYD (CLINICAL PROGRAM MANAGER)
(408) 832-0832
Entity
Organization
Contact information
Practice address
209 LEMOS AVE, SANTA CRUZ, CA 95060-5114
(831) 421-9918
Mailing address
209 LEMOS AVE, SANTA CRUZ, CA 95060-5114
(831) 421-9918
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
20903
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A5480825
DRIVER'S LICENSE
CA
Enumeration date
11/28/2006
Last updated
08/22/2020
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