Basic Information
| Provider Information | |||||||||
| NPI: | 1598986010 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COUNTY OF SOLANO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 275 BECK AVE # MS 5-215 | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945336804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7077848575 | ||||||||
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| Practice Location | |||||||||
| Address1: | 355 TUOLUMNE ST | ||||||||
| Address2: | |||||||||
| City: | VALLEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945905700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075535509 | ||||||||
| FaxNumber: | 7075535658 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 07/14/2010 | ||||||||
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| AuthorizedOfficialLastName: | LAPIRA | ||||||||
| AuthorizedOfficialFirstName: | MARIA | ||||||||
| AuthorizedOfficialMiddleName: | TERESA L | ||||||||
| AuthorizedOfficialTitleorPosition: | HSS FINANCIAL SERVICES MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7077848584 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COUNTY OF SOLANO | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | FHC11489F | 05 | CA | MEDICAID | 005537 | 01 | CA | CMSP BC VLO | OTHER |