Healthcare Provider Details

I. General information

NPI: 1922452747
Provider Name (Legal Business Name): OHLONE COMMUNITY COLLEGE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43600 MISSION BLVD
FREMONT CA
94539-5847
US

IV. Provider business mailing address

43600 MISSION BLVD STUDENT HEALTH CENTER
FREMONT CA
94539-5847
US

V. Phone/Fax

Practice location:
  • Phone: 510-659-6258
  • Fax:
Mailing address:
  • Phone: 510-659-6258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: DR. MINH-HOA TA
Title or Position: VICE PRESIDENT OF STUDENT SERVICES
Credential:
Phone: 510-659-6107