Healthcare Provider Details

I. General information

NPI: 1427224914
Provider Name (Legal Business Name): SAN MATEO COMMUNITY COLLEGE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W HILLSDALE BLVD BLDG 1-226
SAN MATEO CA
94402-3757
US

IV. Provider business mailing address

3401 CSM DR
SAN MATEO CA
94402-3651
US

V. Phone/Fax

Practice location:
  • Phone: 650-574-6396
  • Fax:
Mailing address:
  • Phone: 650-358-6767
  • Fax:

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: HARRY JOEL
Title or Position: VICE CHANCELLOR
Credential:
Phone: 650-358-6767