| Organization Name: | DEPARTMENT OF HEALTH SERVICES |
| NPI Number: | 1952637027 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DIANA L STORNETTA (COMPLIANCE AUDITOR) |
| Mailing Address: | 140 S Cloverdale Blvd Cloverdale |
| State: | CA US |
| Postal Code: | 954253710 |
| Phone Number: | 7078944715 |
| Fax Number: | |
| NPI Enumeration Date: | 10/26/2009 |
| NPI Last Update Date: | 07/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QC1500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |