Provider Demographics
NPI:1154732477
Name:USP ATWATER
Entity type:Organization
Organization Name:USP ATWATER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:
Authorized Official - Last Name:METTRY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:209-386-4791
Mailing Address - Street 1:1 FEDERAL WAY
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-5174
Mailing Address - Country:US
Mailing Address - Phone:209-386-4791
Mailing Address - Fax:
Practice Address - Street 1:1 FEDERAL WAY
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-5174
Practice Address - Country:US
Practice Address - Phone:209-386-4791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FEDERAL BUREAU OF PRISONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare