Healthcare Provider Details

I. General information

NPI: 1265673404
Provider Name (Legal Business Name): COLLEGE COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 7TH ST
WASCO CA
93280-1820
US

IV. Provider business mailing address

1217 7TH ST
WASCO CA
93280-1820
US

V. Phone/Fax

Practice location:
  • Phone: 661-758-4029
  • Fax: 661-758-0891
Mailing address:
  • Phone: 661-758-4029
  • Fax: 661-758-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIA L RODRIGUEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 661-758-4029