Healthcare Provider Details

I. General information

NPI: 1437079175
Provider Name (Legal Business Name): CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILIATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 QUEBEC AVE
CORCORAN CA
93212-9715
US

IV. Provider business mailing address

106 CAYUGA AVE
SAN FRANCISCO CA
94112-1416
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: RAQUEL MERCEDES ZUMAETA
Title or Position: CLINICAL PSYCHOLOGY INTERN
Credential:
Phone: 415-706-5658