Healthcare Provider Details

I. General information

NPI: 1144340670
Provider Name (Legal Business Name): CAL STATE SAN MARCOS STUDENT HEALTH & COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S TWIN OAKS VALLEY RD
SAN MARCOS CA
92096-0001
US

IV. Provider business mailing address

333 S TWIN OAKS VALLEY RD
SAN MARCOS CA
92096-0001
US

V. Phone/Fax

Practice location:
  • Phone: 760-750-4915
  • Fax: 760-750-3181
Mailing address:
  • Phone: 760-750-4915
  • Fax: 760-750-3181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KAREN HAYNES
Title or Position: UNIVERSITY PRESIDENT
Credential: PH.D.
Phone: 760-750-4040