Provider Demographics
NPI:1144464025
Name:CHICO STATE UNIVERSITY, STUDENT HEALTH SERVICE
Entity type:Organization
Organization Name:CHICO STATE UNIVERSITY, STUDENT HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF STUDENT HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-898-3118
Mailing Address - Street 1:400 WEST FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95929-0777
Mailing Address - Country:US
Mailing Address - Phone:530-898-5241
Mailing Address - Fax:530-898-4057
Practice Address - Street 1:WARNER AVE & COLLEGE DR
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95929-0777
Practice Address - Country:US
Practice Address - Phone:530-898-5241
Practice Address - Fax:530-898-4057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health