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General NPI Number Information
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NPI Number | 1316308380
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Entity Type | Organization
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Legal Business Name | CITRUS COMMUNITY COLLEGE
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Dates
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Enumeration Date | 03/17/2016
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Last Update Date | 03/17/2016
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Provider Practice Location Address
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Address Line | 1000 W FOOTHILL BLVD
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City | GLENDORA
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State | CA
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Zip | 91741-1885
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Country | US
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Telephone | 626-914-8671
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 W FOOTHILL BLVD
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City | GLENDORA
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State | CA
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Zip | 91741-1885
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Country | US
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Telephone | 626-914-8671
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Fax |
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Authorized Official
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Title or Position | DIRECTOR , STUDENT HEALTH CENTER
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Name | DR. SHAUNA GORHAM BIGBY
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Credential | DNP
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Telephone | 626-914-8671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 53224
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License Number State | CA
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