Basic Information
| Provider Information | |||||||||
| NPI: | 1356473862 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COUNTY OF MONTEREY | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | MONTEREY OUTPATIENT MH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 299 12TH STREET, | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MARINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316477832 | ||||||||
| FaxNumber: | 8316477940 | ||||||||
| Practice Location | |||||||||
| Address1: | 299 12TH STREET, | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MARINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316477832 | ||||||||
| FaxNumber: | 8316477940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2007 | ||||||||
| LastUpdateDate: | 06/12/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SEMO | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MRT | ||||||||
| AuthorizedOfficialTelephone: | 8317961653 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.