Healthcare Provider Details

I. General information

NPI: 1710180989
Provider Name (Legal Business Name): STUDENT HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 09/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 STUDENT HEALTH
IRVINE CA
92697-5200
US

IV. Provider business mailing address

501 STUDENT HEALTH
IRVINE CA
92697
US

V. Phone/Fax

Practice location:
  • Phone: 949-824-5940
  • Fax: 949-824-1378
Mailing address:
  • Phone: 949-824-7010
  • Fax: 949-824-1378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License NumberY326259
License Number StateCA

VIII. Authorized Official

Name: MR. JOHN PATRICK HAINES
Title or Position: EXECUTIVE DIRECTOR
Credential: MBA, CMPE
Phone: 949-824-9416