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General NPI Number Information
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NPI Number | 1871764175
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Entity Type | Organization
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Legal Business Name | COUNTY OF SAN BERNARDINO
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 03/14/2008
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Provider Practice Location Address
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Address Line | NORTH & SOUTH BOUND I-15 @ ZZZ
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City | BAKER
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State | CA
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Zip | 92309
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Country | US
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Telephone | 909-387-5902
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Fax |
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Provider Business Mailing Address
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Address Line | 157 WEST 5TH ST 2ND FLOOR
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City | SAN BERNARDINO
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State | CA
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Zip | 92415-0451
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Country | US
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Telephone | 909-387-5902
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Fax | 909-387-5685
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Authorized Official
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Title or Position | SUPERVISOR FISCAL TECH II
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Name | MRS. ELIZABETH URISTA
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Credential |
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Telephone | 909-387-5959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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