Provider Demographics
NPI:1033668066
Name:SAN BERNARDINO COUNTY SUPERINTENDENT OF SCHOOLS
Entity Type:Organization
Organization Name:SAN BERNARDINO COUNTY SUPERINTENDENT OF SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-748-0259
Mailing Address - Street 1:14625 MANZANO RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-8683
Mailing Address - Country:US
Mailing Address - Phone:909-223-5776
Mailing Address - Fax:
Practice Address - Street 1:1812 W PARK AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8014
Practice Address - Country:US
Practice Address - Phone:909-748-0259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health