Healthcare Provider Details

I. General information

NPI: 1841521770
Provider Name (Legal Business Name): FEDERAL CORRECTIONAL INSTITUTION DUBLIN, CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 8TH STREET
DUBLIN CA
94568
US

IV. Provider business mailing address

5701 8ST FEDERAL CORRECTIONAL , DUBLIN,CA
DUBLIN CA
94568
US

V. Phone/Fax

Practice location:
  • Phone: 925-833-7500
  • Fax: 925-833-7595
Mailing address:
  • Phone: 925-833-7500
  • Fax: 925-833-7595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberA41553
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number33616
License Number StateMN

VIII. Authorized Official

Name: MRS. LUISA MERCEDES ABARCA-BASILE
Title or Position: HEALTH SERVICES ADMINISTRATOR
Credential: FMG
Phone: 925-833-7500