NPIMap

Organization Active NPI

Santa Cruz County CCS

  • Physical Therapy Clinic/Center
  • Watsonville, CA
National Provider Identifier
1629284609
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
SANTA CRUZ COUNTY CCS
Practice address
140 Herman Ave
Watsonville, CA 95076-2920
Phone
(831) 688-8400
Fax
(831) 722-1114
NPI assigned
May 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Chris Dybdahl
Title
Senior Program Manager
Phone
(831) 763-8914

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

140 Herman Ave
Watsonville, CA 95076-2920

Mailing address

1080 Emeline Ave
Santa Cruz, CA 95060-1966
Phone (831) 622-8400

Other identifiers 1

IdentifierTypeStateIssuer
CCS00065FMedicaidCA

Other names 1

  • DUNCAN HOLBERT MTU Other name

National Provider Directory

National Provider Directory
Tax ID family
Puentes Al Sur24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

Locations

140 Herman Ave
Watsonville, CA 95076
Phone (805) 821-1585

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629284609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1080 EMELINE AVE",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950601966",
            "telephone_number": "831-622-8400",
            "fax_number": "831-761-6167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 HERMAN AVE",
            "city": "WATSONVILLE",
            "state": "CA",
            "postal_code": "950762920",
            "telephone_number": "831-688-8400",
            "fax_number": "831-722-1114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA CRUZ COUNTY CCS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DYBDAHL",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "SENIOR PROGRAM MANAGER",
        "authorized_official_telephone_number": "831-763-8914",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CCS00065F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DUNCAN HOLBERT MTU",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Watsonville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.