Provider Demographics
NPI:1730205154
Name:CALIFORNIA STATE UNIVERSITY SAN BERNARDINO
Entity type:Organization
Organization Name:CALIFORNIA STATE UNIVERSITY SAN BERNARDINO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:JAWORSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-537-3070
Mailing Address - Street 1:37500 COOK ST
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-2900
Mailing Address - Country:US
Mailing Address - Phone:909-289-2965
Mailing Address - Fax:909-537-7027
Practice Address - Street 1:5500 UNIVERSITY PKWY
Practice Address - Street 2:STUDENT HEALTH CENTER
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-2318
Practice Address - Country:US
Practice Address - Phone:909-537-3295
Practice Address - Fax:909-537-7027
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALIFORNIA STATE UNIVERSITY SAN BERNARDINO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-21
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health