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General NPI Number Information
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NPI Number | 1184703381
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Entity Type | Organization
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Legal Business Name | SAN DIEGO STATE UNIVERSITY STUDENT HEALTH SERVICES
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5500 CAMPANILE DR
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City | SAN DIEGO
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State | CA
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Zip | 92182-4701
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Country | US
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Telephone | 619-594-4325
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Fax | 619-594-4260
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Provider Business Mailing Address
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Address Line | 5500 CAMPANILE DR
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City | SAN DIEGO
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State | CA
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Zip | 92182-4701
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Country | US
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Telephone | 619-594-4325
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Fax | 619-594-4260
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Authorized Official
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Title or Position | ASSOCIATE VICE PRESIDENT BUSINESS E
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Name | MR. DAVID SCOTT BURNS
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Credential |
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Telephone | 619-594-6018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | HPE 14078
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License Number State | CA
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