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General NPI Number Information
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NPI Number | 1174573802
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF STATE HOSPITALS
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 10/19/2021
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Provider Practice Location Address
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Address Line | 10333 EL CAMINO REAL
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City | ATASCADERO
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State | CA
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Zip | 93422-5808
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Country | US
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Telephone | 805-468-2000
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Fax | 805-468-6011
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Provider Business Mailing Address
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Address Line | 1215 O ST # MS -3
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City | SACRAMENTO
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State | CA
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Zip | 95814-5804
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Country | US
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Telephone | 916-651-8906
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Fax | 916-651-8908
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Authorized Official
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Title or Position | ADMINISTRATIVE DEPUTY DIRECTOR
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Name | GUADALUPE M ALONZO-DIAZ
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Credential |
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Telephone | 916-654-2655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 150000498
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number | 150000498
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 150000498
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 150000498
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 150000498
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 150000498
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License Number State | CA
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