DEPARTMENT OF STATE HOSPITAL COALINGA (NPI# 1780181222) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780181222 |
| Entity Type | Organization |
| Organization Name | DEPARTMENT OF STATE HOSPITAL COALINGA |
| Other Organization Name | COALINGA STATE HOSPITAL |
| Practice Address |
24511 W Jayne Ave Coalinga CA 93210-9516 |
| Practice Telephone | 5599354300 |
| Mailing Telephone | 5599354300 |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2018-04-11 |
| Authorized Official Name | DR. JEOUNG PARK (CLINICAL PSYCHOLOGIST) |
| Authorized Official Telephone | 5599343201 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2400X |
Clinic/Center Specialization: Prison Health |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Coalinga State Hospital | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275079865 | Department of State Hospital Coalinga | Psychiatric Hospital | 24511 W Jayne Ave, Coalinga, CA 93210-9503 | 2017-01-06 |
| Street Address |
24511 W JAYNE AVE |
| City | COALINGA |
| State | CA |
| Zip Code | 93210-9516 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598753956 | Jong Yeoung Moon | Internal Medicine | 24511 W Jayne Ave, Coalinga, CA 93210-9503 | 2005-10-11 |
| 1649815580 | Brittany Shaffer | Psychologist | 24511 W Jayne Ave, Coalinga, CA 93210-9503 | 2019-11-14 |
| 1093289860 | David Aitken Jr. | Psychologist | 24511 W Jayne Ave, Coalinga, CA 93210-9503 | 2019-01-15 |
| 1811479173 | Thai-son Nguyen | Pharmacist | 24511 W Jayne Ave, Coalinga, CA 93210-9503 | 2018-09-04 |
| 1740760461 | Jeffrey Jay Davis | Psychologist | 24511 W Jayne Ave, Coalinga, CA 93210-9503 | 2018-08-21 |
| 1114415312 | Alynna Pena | Psychologist | 24511 W Jayne Ave, Coalinga, CA 93210 | 2018-04-24 |
| 1770070922 | Kevin John Miller | Psychologist | 24511 W Jayne Ave, Coalinga, CA 93210-9503 | 2018-04-13 |
| 1366949687 | Destarte Lindaine Good | Counselor | 24511 W Jayne Ave, Coalinga, CA 93210-9503 | 2018-04-12 |
| 1215434543 | Jheanett Portobanco | Psychologist | 24511 W Jayne Ave, Coalinga, CA 93210-9503 | 2018-04-12 |
| 1396242855 | Christopher Stack | Psychologist | 24511 W Jayne Ave, Coalinga, CA 93210-9503 | 2018-04-11 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427684257 | Corrections and Rehabilitation | Pharmacy | 24863 W. Jayne Avenue, Coalinga, CA 93210 | 2020-03-12 |
| 1710524293 | Harpreet Kaur Badhesha | Registered Nurse | 191 E Polk St, Coalinga, CA 93210 | 2019-12-04 |
| 1669019139 | Avenal Community Health Center | Clinic/Center | 191 E Polk St., Coalinga, CA 93210 | 2019-12-04 |
| 1194218503 | Elizabeth Armstrong | Registered Nurse | 400 W Forest Ave, Appartment # 133, Coalinga, CA 93210 | 2018-06-11 |
| 1003151713 | Porfirio Ramos | Pharmacist | 24511 W. Jayne Avenue, Coalinga State Hospital Pharmacy Department, Coalinga, CA 93210 | 2012-12-06 |
| 1548504251 | Tonya Kay Green | Pharmacist | 265 Forrest Street, Coalinga, CA 93210 | 2012-11-19 |
| 1205105772 | Ratana Yun | Pharmacist | 24863 W. Jayne Ave, Pvsp Pharmacy Department, Coalinga, CA 93210 | 2011-12-29 |
| 1326374166 | Valerie Ann Kelly | Social Worker | 24683 W. Jayne Ave, Coalinga, CA 93210 | 2009-10-29 |
| 1427298850 | Michael Torres Rodriguez I | Counselor | 25863 Jayne Avenue, Coalinga, CA 93210 | 2009-02-25 |
| 1659537819 | Ikumi Hirashima Bisbee | Registered Nurse | 2455 W. Jayne Ave., Coalinga, CA 93210 | 2008-08-06 |
| Find all providers in zip 93210 | ||||
| Taxonomy Code | 261QP2400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Prison Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801435631 | County of Sacramento | Clinic/Center | 651 I Street, Sacramento, CA 95814 | 2019-12-26 |
| 1801430418 | Federal Correctional Complex Lompoc | Clinic/Center | 3901 Klein Blvd, Lompoc, CA 93436-2706 | 2019-11-06 |
| 1861052060 | County of San Mateo | Clinic/Center | 1300 Maple St., Redwood City, CA 94063 | 2019-06-19 |
| 1750941977 | County of San Mateo | Clinic/Center | 300 Bradford St., Redwood City, CA 94063 | 2019-06-19 |
| 1669032868 | County of San Mateo | Clinic/Center | 222 Paul Scannell Dr., San Mateo, CA 94402 | 2019-06-19 |
| 1841620689 | Orange County Health Care Agency | Clinic/Center | 550 N. Flower Street, Santa Ana, CA 92706 | 2013-11-14 |
| 1154621555 | American Correctional Solutions, Inc. | Clinic/Center | 1588 N Batavia St, Orange, CA 92867-3553 | 2010-11-01 |
| 1104033661 | Jail Health Services Pharmacy | Clinic/Center | 1 Moreland Drive Cj#5 Pharmacy, San Bruno, CA 94066-1670 | 2007-05-16 |
| 1598847519 | Jail Psych Services - Rccc | Clinic/Center | 12450 Bruceville Rd, Elk Grove, CA 95757-9784 | 2006-10-19 |
| 1467982017 | California Forensic Medical Group, Inc. | Clinic/Center | 5325 Broder Blvd, Dublin, CA 94568-3309 | 2017-06-15 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.