Healthcare Provider Details

I. General information

NPI: 1508924721
Provider Name (Legal Business Name): COMMUNITY ACTION COMMSSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W CHESTNUT AVE
LOMPOC CA
93436-5913
US

IV. Provider business mailing address

120 W. CHESTNUT
LOMPOC CA
93436
US

V. Phone/Fax

Practice location:
  • Phone: 805-740-4555
  • Fax: 805-740-4558
Mailing address:
  • Phone: 805-740-4555
  • Fax: 805-740-4558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. DAVID SCOTT
Title or Position: QA
Credential: PSY.D
Phone: 805-260-4676