Individual
ETHAN JOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
110 COOPER ST # 500, SANTA CRUZ, CA 95060-4574
(831) 425-4100
Mailing address
3324 MALIBU DR, SANTA CRUZ, CA 95062-2024
(510) 386-0823
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
A194810
CA
Other
Enumeration date
06/12/2020
Last updated
08/15/2024
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