Healthcare Provider Details

I. General information

NPI: 1407189525
Provider Name (Legal Business Name): SAN BERNARDINO VALLEY COLLEGE, STUDENT HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 09/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S MOUNT VERNON AVE STUDENT HEALTH SERVICES
SAN BERNARDINO CA
92410-2705
US

IV. Provider business mailing address

701 S MOUNT VERNON AVE STUDENT HEALTH SERVICES
SAN BERNARDINO CA
92410-2705
US

V. Phone/Fax

Practice location:
  • Phone: 909-038-4449
  • Fax: 909-888-2357
Mailing address:
  • Phone: 909-038-4449
  • Fax: 909-888-2357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number280062
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number280062
License Number StateCA

VIII. Authorized Official

Name: ELAINE AKERS
Title or Position: COORDINATOR STUDENT HEALTH SERVICES
Credential: REGISTERED NURSE
Phone: 909-384-4495