Organization
COUNTY OF TUOLUMNE
Active
Organization
COUNTY OF TUOLUMNE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMI DEMELLO MARISCAL (COMPLIANCE AND IS MANAGER)
(209) 533-6245
Entity
Organization
Contact information
Practice address
105 HOSPITAL RD, SONORA, CA 95370-5227
(209) 533-6245
(209) 588-9563
Mailing address
2 S GREEN ST, SONORA, CA 95370-4618
(209) 533-6245
(209) 588-9563
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G91276
—
CA
Enumeration date
08/08/2019
Last updated
09/25/2019
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