Organization
DSH-ATASCADERO
Active
Organization
DSH-ATASCADERO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID FENNELL MD (MEDICAL DIRECTOR)
(805) 468-2005
Entity
Organization
Contact information
Practice address
10333 EL CAMINO REAL, ATASCADERO, CA 93422-5808
(805) 468-2000
Mailing address
3370 COLIMA RD, ATASCADERO, CA 93422-2510
(805) 461-5764
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
G34082
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G34082
MEDICAL LICENSE
CA
Enumeration date
10/20/2015
Last updated
03/07/2023
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