1073783239 NPI number — COUNTY OF SAN BERNARDINO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073783239 NPI number — COUNTY OF SAN BERNARDINO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF SAN BERNARDINO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073783239
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
351 NORTH MOUNTAIN VIEW AVENUE
Provider Second Line Business Mailing Address:
ROOM 303
Provider Business Mailing Address City Name:
SAN BERNARDINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92415-0010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-387-6219
Provider Business Mailing Address Fax Number:
909-387-6228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 EAST MOUNTAIN VIEW STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARSTOW
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92311-2840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-256-4715
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RAYMUNDO
Authorized Official First Name:
GERTRUDE
Authorized Official Middle Name:
Authorized Official Title or Position:
PUBLIC HEALTH DIRECTOR
Authorized Official Telephone Number:
909-387-9146

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZT11488F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LAB65059F . This is a "LAB" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com