Provider Demographics
NPI:1518398080
Name:CORRECTIONAL HEALTH SERVICES
Entity Type:Organization
Organization Name:CORRECTIONAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE ANN
Authorized Official - Middle Name:VELORIA
Authorized Official - Last Name:DUNGAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-382-8797
Mailing Address - Street 1:1414 CITY LIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2648
Mailing Address - Country:US
Mailing Address - Phone:949-382-8797
Mailing Address - Fax:
Practice Address - Street 1:1414 CITY LIGHTS DR
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-2648
Practice Address - Country:US
Practice Address - Phone:949-382-8797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA638734282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA19394098OtherKAISER PERMANENTE MEDICAL NUMBER