Provider Demographics
NPI:1144340670
Name:CAL STATE SAN MARCOS STUDENT HEALTH & COUNSELING SERVICES
Entity type:Organization
Organization Name:CAL STATE SAN MARCOS STUDENT HEALTH & COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UNIVERSITY PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:760-750-4040
Mailing Address - Street 1:333 S TWIN OAKS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92096-0001
Mailing Address - Country:US
Mailing Address - Phone:760-750-4915
Mailing Address - Fax:760-750-3181
Practice Address - Street 1:333 S TWIN OAKS VALLEY RD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92096-0001
Practice Address - Country:US
Practice Address - Phone:760-750-4915
Practice Address - Fax:760-750-3181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEXE70130FOtherMEDI-CAL PROVIDER NUMBER