- Enrollment id
- O20091016000078
- Enrollment state
- CA
- Provider type code
- 00-04
- Provider type text
- PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)
- Npi
- 1740232644
- Multiple npi flag
- N
- Ccn
- 551003
- Associate id
- 2466345632
- Organization name
- COUNTY OF MONTEREY
- Doing business as name
- LAUREL FAMILY PRACTICE
- Organization type structure
- OTHER
- Organization other type text
- FQHC
- Proprietary nonprofit
- N
- Address line 1
- 1441 CONSTITUTION BLVD
- Address line 2
- BLDG 400 SUITE 300
- City
- SALINAS
- State
- CA
- Zip code
- 939063100
- Telephone number
- 8317554123