Healthcare Provider Details

I. General information

NPI: 1568004174
Provider Name (Legal Business Name): CALIFORNIA SUBSTANCE ABUSE TREATMENT FACILITY-STATE PRISON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 QUEBEC AVE
CORCORAN CA
93212-9715
US

IV. Provider business mailing address

900 QUEBEC AVE
CORCORAN CA
93212-9715
US

V. Phone/Fax

Practice location:
  • Phone: 559-992-7100
  • Fax: 559-992-7201
Mailing address:
  • Phone: 559-992-7100
  • Fax: 559-992-7201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. NORMAN KARL ROSENBLATT
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM.D.
Phone: 559-992-7100