Organization
1150 MAIN STREET INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRLEY L DICKINSON M.D. (MANAGER)
(831) 728-0551
Entity
Organization
Contact information
Practice address
1150 MAIN ST STE 3, WATSONVILLE, CA 95076-3760
(831) 728-0551
(831) 728-3679
Mailing address
1150 MAIN ST STE 3, WATSONVILLE, CA 95076-3760
(831) 728-0551
(831) 728-3679
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G56281
CA
Other
Enumeration date
07/01/2013
Last updated
07/01/2013
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