=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386871796
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DELTA OAK MENTAL HEALTH PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2009
-----------------------------------------------------
Last Update Date | 06/12/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1540 38TH ST
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95816-6712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-212-9255
-----------------------------------------------------
Fax | 425-212-9302
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3307 RUCKER AVE C/O MCPARTNERS, INC.
-----------------------------------------------------
City | EVERETT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98201-4226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-212-9255
-----------------------------------------------------
Fax | 425-212-9302
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | WOLFGANG W KLAMP
-----------------------------------------------------
Credential | PH.D., MBA
-----------------------------------------------------
Telephone | 425-212-9255
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 273R00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital Unit
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------