=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710350384
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH KERN STATE PRISON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2015
-----------------------------------------------------
Last Update Date | 11/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2737 WEST CECIL AVE
-----------------------------------------------------
City | DELANO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-721-2345
-----------------------------------------------------
Fax | 661-721-6252
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2737 WEST CECIL AVE
-----------------------------------------------------
City | DELANO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-721-2345
-----------------------------------------------------
Fax | 661-721-6252
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST IN CHARGE
-----------------------------------------------------
Name | DR. BETH CARON SPIEGEL
-----------------------------------------------------
Credential | PHARM.D.
-----------------------------------------------------
Telephone | 661-721-6269
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2400X
-----------------------------------------------------
Taxonomy Name | Prison Health Clinic/Center
-----------------------------------------------------
License Number | LCF39290
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------