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Contact Information

CDCR
4001 HIGHWAY 104
IONE, CA95640
 Phone: 209-274-4911
 Fax: 209-274-5147
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychologist

103T00000X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for CDCR

NPI Number 1134558240
LBN Legal business name CDCR
Authorized official KO FANG - (PSYCHOLOGIST)
Entity Organization
Organization subpart 1 No
Enumeration date 11/08/2013
Last updated 11/08/2013 - About 13 years ago
Identifiers
CA License # PSY18841
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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