Healthcare Provider Details

I. General information

NPI: 1700620127
Provider Name (Legal Business Name): MT. SAN JACINTO COMMUNITY COLLEGE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28237 LA PIEDRA RD
MENIFEE CA
92584-8947
US

IV. Provider business mailing address

28237 LA PIEDRA RD
MENIFEE CA
92584-8947
US

V. Phone/Fax

Practice location:
  • Phone: 951-465-8371
  • Fax:
Mailing address:
  • Phone: 951-465-8371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHAEL BECKHAM
Title or Position: INTERIM VP OF BUSINESS SERVICES
Credential:
Phone: 951-487-3100