Basic Information
| Provider Information | |||||||||
| NPI: | 1437285137 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VISALIA YOUTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 NW 2ND AVE | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932913672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596271490 | ||||||||
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| Practice Location | |||||||||
| Address1: | 109 NW 2ND AVE | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932913672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596271490 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | RAMOS | ||||||||
| AuthorizedOfficialFirstName: | ROBBIE | ||||||||
| AuthorizedOfficialMiddleName: | MATHEW | ||||||||
| AuthorizedOfficialTitleorPosition: | MHRW | ||||||||
| AuthorizedOfficialTelephone: | 5596271490 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
No ID Information.