1790967453 NPI number — FRESNO STATE UNIVERSITY HEALTH AND PSYCHOLOGICAL SERVICEDS

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 1790967453 NPI number — FRESNO STATE UNIVERSITY HEALTH AND PSYCHOLOGICAL SERVICEDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRESNO STATE UNIVERSITY HEALTH AND PSYCHOLOGICAL SERVICEDS
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:
1790967453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UNIVERSITY HEALTH AND PSYCHOLOGICAL SERVICES
Provider Second Line Business Mailing Address:
5044 NORTH BARTON AVENUE M/S HC81
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93740-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-278-6715
Provider Business Mailing Address Fax Number:
559-278-5409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIVERSITY HEALTH AND PSYCHOLOGICAL SERVICES
Provider Second Line Business Practice Location Address:
5044 NORTH BARTON AVENUE M/S HC81
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93740-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-278-6715
Provider Business Practice Location Address Fax Number:
559-278-5409
Provider Enumeration Date:
12/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RUTHRAUFF
Authorized Official First Name:
DIRK
Authorized Official Middle Name:
MARTIN
Authorized Official Title or Position:
ASSOCIATE DIRECTOR
Authorized Official Telephone Number:
559-278-6717

Provider Taxonomy Codes

  • Taxonomy code: 261QS1000X , with the licence number:  N/A ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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