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General NPI Number Information
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NPI Number | 1346667268
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Entity Type | Organization
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Legal Business Name | CALIFORNIA INSTITUE FOR MEN
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Dates
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Enumeration Date | 03/28/2014
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Last Update Date | 03/28/2014
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Provider Practice Location Address
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Address Line | 14901 CENTRAL AVE
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City | CHINO
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State | CA
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Zip | 91710-9500
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Country | US
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Telephone | 909-597-1821
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Fax | 909-606-4332
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Provider Business Mailing Address
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Address Line | 14901 CENTRAL AVE
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City | CHINO
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State | CA
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Zip | 91710-9500
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Country | US
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Telephone | 909-597-1821
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Fax | 909-606-4332
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Authorized Official
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Title or Position | PHARMACIST INCHARGE
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Name | MR. KERIM BANGOU
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Credential | PHARM.D
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Telephone | 909-597-1821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | 44274
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License Number State | CA
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