Provider Demographics
NPI:1275079865
Name:DEPARTMENT OF STATE HOSPITAL COALINGA
Entity Type:Organization
Organization Name:DEPARTMENT OF STATE HOSPITAL COALINGA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST 1
Authorized Official - Prefix:MRS
Authorized Official - First Name:TU
Authorized Official - Middle Name:VIET
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:559-935-4300
Mailing Address - Street 1:24511 W JAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210-9503
Mailing Address - Country:US
Mailing Address - Phone:559-535-4300
Mailing Address - Fax:559-934-3909
Practice Address - Street 1:24511 W JAYNE AVE
Practice Address - Street 2:
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-9503
Practice Address - Country:US
Practice Address - Phone:559-535-4300
Practice Address - Fax:559-934-3909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH45269283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital