Provider Demographics
NPI:1043281561
Name:COUNTY OF SAN BERNARDINO
Entity Type:Organization
Organization Name:COUNTY OF SAN BERNARDINO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUBLIC HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYMUNDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-387-9146
Mailing Address - Street 1:150 E HOLT BLVD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-1613
Mailing Address - Country:US
Mailing Address - Phone:909-458-9430
Mailing Address - Fax:909-986-3590
Practice Address - Street 1:150 E HOLT BLVD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-1613
Practice Address - Country:US
Practice Address - Phone:909-458-9430
Practice Address - Fax:909-986-3590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT11488FMedicaid
CALAB65059FOtherLAB
CAZZZ75903ZMedicare PIN