Healthcare Provider Details

I. General information

NPI: 1851051551
Provider Name (Legal Business Name): COUNTY OF SAN BERNARDINO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 EAST GILBERT STREET COTTAGE 4
SAN BERNARDINO CA
92415-0936
US

IV. Provider business mailing address

303 E VANDERBILT WAY
SAN BERNARDINO CA
92415-0001
US

V. Phone/Fax

Practice location:
  • Phone: 909-387-7406
  • Fax: 909-387-7047
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: MBA
Phone: 909-388-0882