Basic Information
| Provider Information | |||||||||
| NPI: | 1114126430 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SALINAS VALLEY STATE PRISON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31625 HIGHWAY 101 S | ||||||||
| Address2: | |||||||||
| City: | SOLEDAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939609529 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 31625 HIGHWAY 101 S | ||||||||
| Address2: | |||||||||
| City: | SOLEDAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939609529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316785500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2007 | ||||||||
| LastUpdateDate: | 07/16/2007 | ||||||||
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| AuthorizedOfficialLastName: | ADAMO | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF DENTAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8316785595 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 34192 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | 284300000X | 34192 | CA | Y | Hospitals | Special Hospital |
No ID Information.