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Individual

ACACIA SKY KHAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1400 EMELINE AVE, SANTA CRUZ, CA 95060-1976
(831) 454-4170
Mailing address
1400 EMELINE AVE, SANTA CRUZ, CA 95060-1976
(831) 454-4170

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
FHC 700 42F
COUNTY OF SANTA CRUZ GROUP MEDI-CAL #
CA
01
ZZZ91891Z
COUNTY OF SANTA CRUZ GROUP MEDICARE #
CA
01
ZZZ91892Z
COUNTY OF SANTA CRUZ GROUP MEDICARE #
CA
01
ZZZ92069Z
COUNTY OF SANTA CRUZ GROUP MEDICARE #
CA
Enumeration date
08/29/2013
Last updated
08/29/2013
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