Healthcare Provider Details

I. General information

NPI: 1104342393
Provider Name (Legal Business Name): YOSEMITE COMMUNITY COLLEGE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 COLUMBIA COLLEGE DR
SONORA CA
95370-8560
US

IV. Provider business mailing address

11600 COLUMBIA COLLEGE DRIVE PINYON
SONORA CA
95370
US

V. Phone/Fax

Practice location:
  • Phone: 209-588-5204
  • Fax: 209-588-5240
Mailing address:
  • Phone: 209-588-5204
  • Fax: 209-588-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TREVOR STEWART
Title or Position: VICE PRESIDENT, ADMIN. SERVICES
Credential:
Phone: 209-588-5112