=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396779583
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEHAVIORAL HEALTH HOSPITALISTS MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2245 W HAROLD CT
-----------------------------------------------------
City | VISALIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93291-2696
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-713-0894
-----------------------------------------------------
Fax | 559-713-0894
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7026
-----------------------------------------------------
City | VISALIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93290-7026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-713-0894
-----------------------------------------------------
Fax | 559-713-0894
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PSYCHIATRIST
-----------------------------------------------------
Name | DR. GENE LIBUNAO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 559-713-0894
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | A93689
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------