Healthcare Provider Details

I. General information

NPI: 1659345981
Provider Name (Legal Business Name): CALIFORNIA STATE UNIVERSITY EAST BAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25800 CARLOS BEE BLVD
HAYWARD CA
94542-3000
US

IV. Provider business mailing address

25800 CARLOS BEE BLVD
HAYWARD CA
94542-3000
US

V. Phone/Fax

Practice location:
  • Phone: 510-885-3650
  • Fax:
Mailing address:
  • Phone: 510-885-3650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT G MAR
Title or Position: PHARMACIST IN CHARGE
Credential: PHARMD
Phone: 510-885-3650