1538279195 NPI number — CALIFORNIA STATE UNIVERSITY, SACRAMENTO STUDENT HEALTH CENTER

Table of content: DR. MONICA SHAHBAZNIA ALVAREZ PH.D. (NPI 1740523836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538279195 NPI number — CALIFORNIA STATE UNIVERSITY, SACRAMENTO STUDENT HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA STATE UNIVERSITY, SACRAMENTO STUDENT HEALTH CENTER
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:
1538279195
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6000 J STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95819-6049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-275-6035
Provider Business Mailing Address Fax Number:
916-278-7359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6000 J STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95819-6049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-275-6035
Provider Business Practice Location Address Fax Number:
916-278-7359
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
JOYCE
Authorized Official Middle Name:
Authorized Official Title or Position:
STUDENT HEALTH CENTER, DIRECTOR
Authorized Official Telephone Number:
916-278-6049

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: LAB64016F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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