1932345386 NPI number — UNIVERSITY OF THE PACIFIC

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 1932345386 NPI number — UNIVERSITY OF THE PACIFIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF THE PACIFIC
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:
MARTIN GIPSON SOCIALIZATION CENTER
Provider Other Organization Name Type Code:
5
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:
1932345386
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3601 PACIFIC AVE
Provider Second Line Business Mailing Address:
UOP PSYCHOLOGY DEPARTMENT
Provider Business Mailing Address City Name:
STOCKTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95211-0110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-946-2132
Provider Business Mailing Address Fax Number:
209-946-2284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 E PINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STOCKTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95204-5522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-464-5519
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
HOLLY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
209-946-2132

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 90432 . This is a "OTHER, 90432 CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 90441 . This is a "OTHER 90441 CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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