Active NPI
Jorge A. Duque
- Clinical Social Worker
- Santa Cruz, CA
National Provider Identifier
1962671800
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 65726
- Practice address
- 1080 Emeline Ave
Santa Cruz, CA 95060-1966 - Phone
- (831) 454-4100
- NPI assigned
- Feb 25, 2008
- Last updated
- May 11, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Clinical Social Worker | 1041C0700X | 65726 | CA | Primary |
Addresses
Primary practice location
1080 Emeline Ave
Santa Cruz, CA 95060-1966
Mailing address
PO Box 962
Santa Cruz, CA 95061-0962
Phone (831) 454-4170
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 65726 | CA | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Santa Cruz | Past | Accepting new patients | |
| Puentes Al Sur | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Clinic/Center
- Santa Cruz, CA
- NPI 1659315430
-
dba Health Services Agency-Mental Health Division
- Adult Mental Health Clinic/Center
- Watsonville, CA
- NPI 1992849012
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494460800000",
"number": "1962671800",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 962",
"city": "SANTA CRUZ",
"state": "CA",
"postal_code": "950610962",
"telephone_number": "831-454-4170",
"fax_number": "831-454-4663"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1080 EMELINE AVE",
"city": "SANTA CRUZ",
"state": "CA",
"postal_code": "950601966",
"telephone_number": "831-454-4100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUQUE",
"first_name": "JORGE",
"middle_name": "A.",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-02-25",
"last_updated": "2017-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "65726",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Cruz, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.