Basic Information
| Provider Information | |||||||||
| NPI: | 1497058317 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COUNTY OF SOLANO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 COURAGE DR | ||||||||
| Address2: | MS 10-100 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945336717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7077842220 | ||||||||
| FaxNumber: | 7077842204 | ||||||||
| Practice Location | |||||||||
| Address1: | 2101 COURAGE DR | ||||||||
| Address2: | MS 10-100 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945336717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7077842220 | ||||||||
| FaxNumber: | 7077842204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2010 | ||||||||
| LastUpdateDate: | 12/15/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DUTERTE | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | O | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR, H & SS | ||||||||
| AuthorizedOfficialTelephone: | 7077848400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 480011IN | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.