| Organization Name: | DEPARTMENT OF STATE HOSPITALS |
| NPI Number: | 1043249204 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK BECKLEY (CHIEF DEPUTY DIRECTOR) |
| Mailing Address: | 3102 E Highland Ave Patton |
| State: | CA US |
| Postal Code: | 923697813 |
| Phone Number: | 9094257552 |
| Fax Number: | 9094256407 |
| NPI Enumeration Date: | 07/01/2006 |
| NPI Last Update Date: | 11/12/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TF0200X |
| License Number: | 170000831 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Forensic |
| Taxonomy Definition: | |