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General NPI Number Information
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NPI Number | 1083063663
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Entity Type | Organization
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Legal Business Name | SAN BERNARDINO COUNTY DEPARTMENT OF PUBLIC HEALTH
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Dates
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Enumeration Date | 06/06/2016
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Last Update Date | 06/06/2016
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Provider Practice Location Address
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Address Line | 1505 SOUTH D STREET
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City | SAN BERNARDINO
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State | CA
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Zip | 92415
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Country | US
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Telephone | 909-524-1585
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Fax |
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Provider Business Mailing Address
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Address Line | 826 AMBER OAKS CIRCLE
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City | POMONA
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State | CA
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Zip | 91767
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | DONNA PANGANIBAN
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Credential | RDN
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Telephone | 909-524-1585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 86037189
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License Number State | CA
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