Healthcare Provider Details

I. General information

NPI: 1073710398
Provider Name (Legal Business Name): CALIFORNIA DEPARTMENT OF CORRECTIONS &REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21633 AVENUE 24
CHOWCHILLA CA
93610-0099
US

IV. Provider business mailing address

21633 AVENUE 24
CHOWCHILLA CA
93610-0099
US

V. Phone/Fax

Practice location:
  • Phone: 559-665-6100
  • Fax:
Mailing address:
  • Phone: 559-665-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberRN#452501 N.P.#8290
License Number StateCA

VIII. Authorized Official

Name: MS. BARBARA L. WOODWARD
Title or Position: NURSE PRACTITIONER
Credential: N.P.
Phone: 559-665-6100