=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093085789
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAPA COUNTY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2012
-----------------------------------------------------
Last Update Date | 01/11/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2344 OLD SONOMA RD
-----------------------------------------------------
City | NAPA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94559-3708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-253-4063
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1526 PEAR TREE LN
-----------------------------------------------------
City | NAPA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94558-6492
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | A & D COUNSELOR III
-----------------------------------------------------
Name | MR. GERARDO ARTURO BUSTOS-ROJAS
-----------------------------------------------------
Credential | CADC II
-----------------------------------------------------
Telephone | 707-225-1664
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 9604139
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------