Basic Information
Provider Information
NPI: 1942835756
EntityType: 2
ReplacementNPI:  
OrganizationName: CORRECTIONS AND REHABILITATION
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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Mailing Information
Address1: P.O. BOX 567
Address2:  
City: DELANO
State: CA
PostalCode: 932160567
CountryCode: US
TelephoneNumber: 6617212345
FaxNumber: 6617216252
Practice Location
Address1: 2737 W. CECIL AVENUE
Address2:  
City: DELANO
State: CA
PostalCode: 93215
CountryCode: US
TelephoneNumber: 6617212345
FaxNumber: 6617216252
Other Information
ProviderEnumerationDate: 03/12/2020
LastUpdateDate: 03/12/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: THARRATT
AuthorizedOfficialFirstName: ROBERT
AuthorizedOfficialMiddleName: STEVEN
AuthorizedOfficialTitleorPosition: STATEWIDE CHIEF MEDICAL EXECUTIVE
AuthorizedOfficialTelephone: 9166919913
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: CORRECTIONS AND REHABILITATION
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: M.D.
NPICertificationDate: 03/12/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
333600000X  Y SuppliersPharmacy 

No ID Information.


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