1150 Main Street Inc
Organization Active NPI Family Medicine Physician · Watsonville, CA
NPI 1912347261 · NPPES record last updated Jul 1, 2013
Key facts
- NPI
- 1912347261
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- G56281 (CA)
- Legal business name
- 1150 MAIN STREET INC
- Practice address
- 1150 Main St Ste 3
Watsonville, CA 95076-3760 - Phone
- (831) 728-0551
- Fax
- (831) 728-3679
- NPI assigned
- Jul 1, 2013
- Organization subpart
- No
Authorized official
- Name
- Shirley L Dickinson, M.D.
- Title
- Manager
- Phone
- (831) 728-0551
Practitioners 1
National Provider Directory
Locations
1150 Main St
Ste 3
Watsonville, CA 95076
Phone (831) 728-0551
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | G56281 | CA | Yes |
Addresses
Primary practice location
1150 Main St Ste 3
Watsonville, CA 95076-3760
Mailing address
1150 Main St Ste 3
Watsonville, CA 95076-3760
Phone (831) 728-0551
Other providers in Watsonville, CA
- A Compassionate Inc
- Birmania Guadalupe Abarca
- Ana Cristina Abundiz Torres
- Access Options, Inc.
- Mariela Aceves
All providers in Watsonville, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 1, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.