Provider Demographics
NPI:1073937363
Name:BISHOP, JEFFREY (LPT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:BISHOP
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 FULTON AVE
Mailing Address - Street 2:205
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825
Mailing Address - Country:US
Mailing Address - Phone:916-484-3570
Mailing Address - Fax:916-484-3577
Practice Address - Street 1:900 FULTON AVE
Practice Address - Street 2:205
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4500
Practice Address - Country:US
Practice Address - Phone:916-484-3570
Practice Address - Fax:916-484-3577
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25842167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician