Healthcare Provider Details

I. General information

NPI: 1740532647
Provider Name (Legal Business Name): COUNTY OF SAN BERNARDINO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 09/01/2022
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W 4TH ST
SAN BERNARDINO CA
92415-0035
US

IV. Provider business mailing address

303 E VANDERBILT WAY
SAN BERNARDINO CA
92415-0026
US

V. Phone/Fax

Practice location:
  • Phone: 909-382-7881
  • Fax:
Mailing address:
  • Phone: 909-388-0801
  • Fax: 909-890-0435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult 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