Healthcare Provider Details

I. General information

NPI: 1295737401
Provider Name (Legal Business Name): DOS PALOS MEMORIAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 MARGUERITE ST
DOS PALOS CA
93620-2339
US

IV. Provider business mailing address

2118 MARGUERITE ST
DOS PALOS CA
93620-2339
US

V. Phone/Fax

Practice location:
  • Phone: 209-392-6121
  • Fax: 209-392-6881
Mailing address:
  • Phone: 209-392-6121
  • Fax: 209-392-6881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number314000000X
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number261QR1300X
License Number StateCA

VIII. Authorized Official

Name: MR. RAY E SMITH
Title or Position: ADMINISTRATOR
Credential:
Phone: 209-392-6121