Healthcare Provider Details

I. General information

NPI: 1619197761
Provider Name (Legal Business Name): COUNTY OF SAN BERNARDINO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 E GILBERT ST
SAN BERNARDINO CA
92404-5413
US

IV. Provider business mailing address

755 E GILBERT ST
SAN BERNARDINO CA
92404-5413
US

V. Phone/Fax

Practice location:
  • Phone: 909-387-7792
  • Fax: 909-387-7177
Mailing address:
  • Phone: 909-387-7792
  • Fax: 909-387-7177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERICA OCHOA
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 909-388-0882