Organization
CAPITOLA PEDIATRICS
Active
Other names
Capitola Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELIZABETH BASKERVILLE M.D. (OWNER/PEDIATRICIAN)
(831) 475-1883
Entity
Organization
Contact information
Practice address
4145 CLARES STREET, SUITE A, CAPITOLA, CA 95010
(831) 476-1933
(831) 476-2677
Mailing address
4145 CLARES STREET, SUITE A, CAPITOLA, CA 95010
(831) 476-1933
(831) 476-2677
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0099151
—
CA
01
—
ZZZ08020Z
BLUE SHIELD ID#-CAP OFFIC
CA
Enumeration date
03/20/2007
Last updated
08/04/2014
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