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NPI Code Detail

MEDICARE: DR. HENRY HANS BJORN AHLSTROM PH.D.

MEDICARE: DR. HENRY HANS BJORN AHLSTROM PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPSY14420CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619945870
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HENRY HANS BJORN AHLSTROM PH.D.
Provider Business Mailing Address
First Line : 1600 9TH ST
Second Line : ROOM 150 FISCAL ALLOCATIONS AND ESTIMATES UNIT
City : SACRAMENTO
State : CA
Zip : 95814-6414
Country : US
Telephone Number : 916-651-9475
Fax Number : 916-651-8908
Provider Business Practice Location Address
First Line : 10333 EL CAMINO REAL
Second Line :
City : ATASCADERO
State : CA
Zip : 93422-5808
Country : US
Telephone Number : 805-468-2000
Fax Number : 805-468-6011
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2006
Last Update Date : 07/15/2013

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