1891872081 NPI number — SAN BERNARDINO COUNTY PUBLIC HEALTH DEPT.

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 1891872081 NPI number — SAN BERNARDINO COUNTY PUBLIC HEALTH DEPT.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN BERNARDINO COUNTY PUBLIC HEALTH DEPT.
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:
6
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:
1891872081
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
451 E VANDERBILT WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN BERNARDINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92408-3641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-387-6218
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4825 MORENO ST
Provider Second Line Business Practice Location Address:
MONTCLAIR MTU
Provider Business Practice Location Address City Name:
MONTCLAIR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91763-1419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-445-1665
Provider Business Practice Location Address Fax Number:
909-445-1622
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OHIKHUARE
Authorized Official First Name:
MAXWELL
Authorized Official Middle Name:
Authorized Official Title or Position:
PUBLIC HEALTH OFFICER
Authorized Official Telephone Number:
909-387-6219

Provider Taxonomy Codes

  • Taxonomy code: 224Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251P0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CCS00089F . This is a "REHAB CLINIC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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