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General NPI Number Information
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NPI Number | 1376659896
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Entity Type | Organization
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Legal Business Name | CALIFORNIA STATE UNIVERSITY, SACRAMENTO STUDENT HEALTH CENTER
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 6000 J STREET
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City | SACRAMENTO
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State | CA
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Zip | 95819-6045
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Country | US
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Telephone | 916-278-6035
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Fax |
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Provider Business Mailing Address
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Address Line | 6000 J STREET
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City | SACRAMENTO
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State | CA
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Zip | 95819-6045
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Country | US
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Telephone | 916-278-6035
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Fax |
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Authorized Official
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Title or Position | SENIOR ASSOCIATE VICE PRESIDENT
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Name | JEANNE MARIE HARRIS VAN DAHLEN
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Credential |
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Telephone | 916-278-1772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number | 261846341
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License Number State | CA
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