Healthcare Provider Details

I. General information

NPI: 1710350384
Provider Name (Legal Business Name): NORTH KERN STATE PRISON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2737 WEST CECIL AVE
DELANO CA
93215
US

IV. Provider business mailing address

2737 WEST CECIL AVE
DELANO CA
93215
US

V. Phone/Fax

Practice location:
  • Phone: 661-721-2345
  • Fax: 661-721-6252
Mailing address:
  • Phone: 661-721-2345
  • Fax: 661-721-6252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License NumberLCF39290
License Number StateCA

VIII. Authorized Official

Name: DR. BETH CARON SPIEGEL
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM.D.
Phone: 661-721-6269