MEDICARE: CSU-MONTEREY BAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1760415863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CSU-MONTEREY BAY

Provider Business Mailing Address
First Line	:	100 WILSON RD
Second Line	:	SUITE 100
City	:	MONTEREY
State	:	CA
Zip	:	93940-7885
Country	:	US
Telephone Number	:	831-649-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 CAMPUS CTR
Second Line	:	BUILDING 80
City	:	SEASIDE
State	:	CA
Zip	:	93955-8000
Country	:	US
Telephone Number	:	831-582-3965
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL MCMILLAN
Credential	:
Telephone Number	:	831-649-1000

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	03/12/2008

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Directions to “CSU-MONTEREY BAY ” Practice Location

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