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General NPI Number Information
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NPI Number | 1033410113
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Entity Type | Organization
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Legal Business Name | CAL POLY UNIVERSITY
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Dates
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Enumeration Date | 11/05/2010
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Last Update Date | 11/05/2010
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Provider Practice Location Address
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Address Line | 3801 W TEMPLE AVE #46
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City | POMONA
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State | CA
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Zip | 91768-2557
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Country | US
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Telephone | 909-869-4222
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Fax | 909-869-4561
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Provider Business Mailing Address
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Address Line | 3801 W TEMPLE AVE #46
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City | POMONA
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State | CA
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Zip | 91768-2557
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Country | US
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Telephone | 909-869-4222
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Fax | 909-869-2741
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. KAY VIERRA
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Credential |
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Telephone | 909-869-2760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 261QOOOX
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License Number State | CA
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