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General NPI Number Information
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NPI Number | 1811126550
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Entity Type | Organization
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Legal Business Name | FCC OAKDALE
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Dates
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Enumeration Date | 07/02/2009
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Last Update Date | 07/02/2009
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Provider Practice Location Address
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Address Line | 5050 EAST WHATLEY ROAD
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City | OAKDALE
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State | LA
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Zip | 71463-5050
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Country | US
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Telephone | 318-335-4466
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Fax | 318-215-2135
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Provider Business Mailing Address
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Address Line | PO BOX 5050 5050 EAST WHATLEY ROAD
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City | OAKDALE
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State | LA
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Zip | 71463-5050
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Country | US
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Telephone | 318-335-4466
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Fax | 318-215-2135
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. SALVADORE VILLALON
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Credential | M.D.
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Telephone | 318-335-4466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2400X
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Taxonomy Name | Prison Health Clinic/Center
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License Number | A80985
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License Number State | CA
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