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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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