1992850515 NPI number — CALIFORNIA STATE UNIVERSITY, FULLERTON

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 1992850515 NPI number — CALIFORNIA STATE UNIVERSITY, FULLERTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA STATE UNIVERSITY, FULLERTON
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:
1992850515
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:
800 N STATE COLLEGE BLVD
Provider Second Line Business Mailing Address:
STUDENT HEALTH & COUNSELING CENTER
Provider Business Mailing Address City Name:
FULLERTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92831-3547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-278-2821
Provider Business Mailing Address Fax Number:
714-278-5525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 N STATE COLLEGE BLVD
Provider Second Line Business Practice Location Address:
STUDENT HEALTH & COUNSELING CENTER
Provider Business Practice Location Address City Name:
FULLERTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92831-3547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-278-2821
Provider Business Practice Location Address Fax Number:
714-278-5525
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WANG
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
Authorized Official Title or Position:
ACTING EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
714-278-2821

Provider Taxonomy Codes

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

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

  • Identifier: GR0081450 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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