Provider Demographics
NPI:1841521770
Name:FEDERAL CORRECTIONAL INSTITUTION DUBLIN, CALIFORNIA
Entity type:Organization
Organization Name:FEDERAL CORRECTIONAL INSTITUTION DUBLIN, CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICES ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUISA
Authorized Official - Middle Name:MERCEDES
Authorized Official - Last Name:ABARCA-BASILE
Authorized Official - Suffix:
Authorized Official - Credentials:FMG
Authorized Official - Phone:925-833-7500
Mailing Address - Street 1:5701 8ST
Mailing Address - Street 2:FEDERAL CORRECTIONAL , DUBLIN,CA
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568
Mailing Address - Country:US
Mailing Address - Phone:925-833-7500
Mailing Address - Fax:925-833-7595
Practice Address - Street 1:5701 8TH STREET
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568
Practice Address - Country:US
Practice Address - Phone:925-833-7500
Practice Address - Fax:925-833-7595
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FEDERAL CORRECTION INSTITUTION DUBLIN,CALIFORNIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41553302F00000X
MN33616261QP2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
No302F00000XManaged Care OrganizationsExclusive Provider Organization