Healthcare Provider Details

I. General information

NPI: 1518708742
Provider Name (Legal Business Name): FEDERAL CORRECTIONAL INSTITUTION TERMINAL ISLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/03/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FEDERAL CORRECTIONAL INSTITUTIONAL TERMINAL ISLAND 1299 SOUTH SEASIDE AVE
SAN PEDRO CA
90731
US

IV. Provider business mailing address

FEDERAL CORRECTIONAL INSTITUTIONAL TERMINAL ISLAND 1299 SOUTH SEASIDE AVE
SAN PEDRO CA
90731
US

V. Phone/Fax

Practice location:
  • Phone: 310-831-8961
  • Fax:
Mailing address:
  • Phone: 310-831-8961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. SYDNEY TRAN
Title or Position: CHIEF PHARMACIST
Credential: PHARM.D.
Phone: 310-831-8961