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General NPI Number Information
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NPI Number | 1942348958
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Entity Type | Organization
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Legal Business Name | CALIFORNIA STATE UNIVERSITY, NORTHRIDGE
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 09/17/2014
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Provider Practice Location Address
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Address Line | 18111 NORDHOFF ST
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City | NORTHRIDGE
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State | CA
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Zip | 91330-8270
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Country | US
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Telephone | 818-677-3666
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Fax | 818-677-7732
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Provider Business Mailing Address
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Address Line | 18111 NORDHOFF ST
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City | NORTHRIDGE
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State | CA
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Zip | 91330-8270
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Country | US
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Telephone | 818-677-3671
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Fax | 818-677-7732
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Authorized Official
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Title or Position | DIRECTOR, STUDENT HEALTH CENTER
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Name | DR. YOLANDA REID CHASSIAKOS
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Credential | M.D.
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Telephone | 818-677-3666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHE19585
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License Number State | CA
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