Healthcare Provider Details

I. General information

NPI: 1891118220
Provider Name (Legal Business Name): CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2014
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY ONE
SAN LUIS OBISPO CA
93406-0144
US

IV. Provider business mailing address

PO BOX 144
SAN LUIS OBISPO CA
93406-0144
US

V. Phone/Fax

Practice location:
  • Phone: 805-547-7900
  • Fax:
Mailing address:
  • Phone: 805-547-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberPSY17187
License Number StateCA

VIII. Authorized Official

Name: DR. HEIDI SWITZER
Title or Position: SUPERVISOR
Credential: PSY.D.
Phone: 805-547-7900