Basic Information
| Provider Information | |||||||||
| NPI: | 1275079865 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEPARTMENT OF STATE HOSPITAL COALINGA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24511 W JAYNE AVE | ||||||||
| Address2: | |||||||||
| City: | COALINGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932109503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595354300 | ||||||||
| FaxNumber: | 5599343909 | ||||||||
| Practice Location | |||||||||
| Address1: | 24511 W JAYNE AVE | ||||||||
| Address2: | |||||||||
| City: | COALINGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932109503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595354300 | ||||||||
| FaxNumber: | 5599343909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2017 | ||||||||
| LastUpdateDate: | 01/06/2017 | ||||||||
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| AuthorizedOfficialLastName: | TRAN | ||||||||
| AuthorizedOfficialFirstName: | TU | ||||||||
| AuthorizedOfficialMiddleName: | VIET | ||||||||
| AuthorizedOfficialTitleorPosition: | PHARMACIST 1 | ||||||||
| AuthorizedOfficialTelephone: | 5599354300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | PHARM. D | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | RPH45269 | CA | Y | Hospitals | Psychiatric Hospital |
No ID Information.