Organization
FRONT ST INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANN M. BUTLER (CEO AND OWNER)
(831) 420-0120
Entity
Organization
Contact information
Practice address
2115 7TH AVE, SANTA CRUZ, CA 95062-1663
(831) 420-0120
(831) 420-0136
Mailing address
2115 7TH AVE, SANTA CRUZ, CA 95062-1663
(831) 420-0120
(831) 420-0136
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24BW8
MEDI-CAL PRV NBR
CA
01
—
4476
MEDI-CAL PRV NBR
CA
01
—
44AU
MEDI-CAL PRV NBR
CA
01
—
44AV
MEDI-CAL PRV NBR
CA
01
—
44AZ
MEDI-CAL PRV NBR
CA
01
—
44CF
MEDI-CAL PRV NBR
CA
Enumeration date
04/25/2007
Last updated
08/17/2022
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