Healthcare Provider Details

I. General information

NPI: 1801430418
Provider Name (Legal Business Name): FEDERAL CORRECTIONAL COMPLEX LOMPOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 KLEIN BLVD
LOMPOC CA
93436-2706
US

IV. Provider business mailing address

3901 KLEIN BLVD
LOMPOC CA
93436-2706
US

V. Phone/Fax

Practice location:
  • Phone: 805-735-2771
  • Fax: 805-737-3105
Mailing address:
  • Phone: 805-735-2771
  • Fax: 805-737-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

# 1
Identifier01
Identifier TypeOTHER
Identifier State
Identifier IssuerFEDERAL PRISON

VIII. Authorized Official

Name: LAWRENCE CROSS
Title or Position: HEALTH SYSTEM ADMINISTRATOR
Credential:
Phone: 805-735-2771