NPIMap

Organization Active NPI

Watsonville Medical Clinic and Aesthetic Clinic, Inc

  • Family Medicine Physician
  • Watsonville, CA
National Provider Identifier
1689994246
Registry record updated Jun 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A80671 Issued in CA
Legal business name
WATSONVILLE MEDICAL CLINIC AND AESTHETIC CLINIC, INC
Practice address
284 Pennsylvania Dr
Suite 1
Watsonville, CA 95076-3768
Phone
(831) 722-8787
Fax
(831) 722-8881
NPI assigned
Jun 7, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2010

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

Authorized official

Name
Hugo Gerardo Mar, PANPI 1942524897
Title
Physician Assistant
Phone
(831) 722-8787

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X A80671 CA Primary

Addresses

Primary practice location

284 Pennsylvania Dr
Suite 1
Watsonville, CA 95076-3768

Mailing address

284 Pennsylvania Dr
Suite 1
Watsonville, CA 95076-3768
Phone (831) 722-8787

Other identifiers 1

IdentifierTypeStateIssuer
PA13256OtherCAPHYSICIAN ASSISTANT NUMBER

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1275868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275868800000",
    "number": "1689994246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "284 PENNSYLVANIA DR",
            "address_2": "SUITE 1",
            "city": "WATSONVILLE",
            "state": "CA",
            "postal_code": "950763768",
            "telephone_number": "831-722-8787",
            "fax_number": "831-722-8881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "284 PENNSYLVANIA DR",
            "address_2": "SUITE 1",
            "city": "WATSONVILLE",
            "state": "CA",
            "postal_code": "950763768",
            "telephone_number": "831-722-8787",
            "fax_number": "831-722-8881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATSONVILLE MEDICAL CLINIC AND AESTHETIC CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-07",
        "last_updated": "2010-06-07",
        "status": "A",
        "authorized_official_last_name": "MAR",
        "authorized_official_first_name": "HUGO",
        "authorized_official_middle_name": "GERARDO",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "831-722-8787",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A80671",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT NUMBER",
            "identifier": "PA13256",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jun 7, 2010; 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.