Basic Information
| Provider Information | |||||||||
| NPI: | 1609352558 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ASPIRANET | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 OYSTER POINT BLVD SUITE 501 | ||||||||
| Address2: | |||||||||
| City: | SOUTH SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940801904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6508664080 | ||||||||
| FaxNumber: | 6508664082 | ||||||||
| Practice Location | |||||||||
| Address1: | 530 KINGS COUNTY DR | ||||||||
| Address2: | |||||||||
| City: | HANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594714050 | ||||||||
| FaxNumber: | 5597131392 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2018 | ||||||||
| LastUpdateDate: | 08/01/2018 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | VERNON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6508664080 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ASPIRANET | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 415200481 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.