Provider Demographics
NPI:1538933262
Name:MIRA COSTA COMMUNITY COLLEGE DISTRICT
Entity type:Organization
Organization Name:MIRA COSTA COMMUNITY COLLEGE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-795-6676
Mailing Address - Street 1:1 BARNARD DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-3899
Mailing Address - Country:US
Mailing Address - Phone:760-795-6675
Mailing Address - Fax:
Practice Address - Street 1:1 BARNARD DR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3899
Practice Address - Country:US
Practice Address - Phone:760-795-6675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty