CALIFORNIA DEPARTMENT OF CORRECTION/ REHABILITATION NPI 1699027730

NPI Information

NPI: 1699027730
Provider Name: CALIFORNIA DEPARTMENT OF CORRECTION/ REHABILITATION

Other Name: DEPARTMENT C&R CORR INSTITUTION/ TEHACHAPI

Classification: Clinic/Center - 261QP2400X
Entity Type: Organization

Specialization: Prison Health

Address:
24900 HIGHWAY 202
TEHACHAPI, CA
ZIP 93561
Phone: (661) 822-4402
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CALIFORNIA DEPARTMENT OF CORRECTION/ REHABILITATION is a prison health clinic center in Tehachapi, CA. CALIFORNIA DEPARTMENT OF CORRECTION/ REHABILITATION NPI is 1699027730. The provider is registered as an organization entity type.
The provider Other Name Is Department C&r Corr Institution/ Tehachapi.

The provider's business location address is:

24900 HIGHWAY 202
TEHACHAPI, CA
ZIP 93561-558
Phone: (661) 822-4402

The provider's authorized official is Nguyet Minh Dam .
The authorized official title is Staff Psychiatrist and has the following contact phone number (661) 822-4402.

The CLIA number assigned to this NPI record is 05D0724220 - prison with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/14/2012 and was last updated on 10/14/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2400X	Clinic/Center	Prison Health	A63214	CALIFORNIA	Yes

What is NPI?

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This page was last updated on: 5/5/2024

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