Provider Demographics
NPI:1306016555
Name:COUNTY OF SAN BERNARDINO
Entity Type:Organization
Organization Name:COUNTY OF SAN BERNARDINO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GERTRUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYMUNDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-387-9146
Mailing Address - Street 1:351 NORTH MOUNTAIN VIEW AVENUE
Mailing Address - Street 2:ROOM 303
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0010
Mailing Address - Country:US
Mailing Address - Phone:909-387-6219
Mailing Address - Fax:909-387-6228
Practice Address - Street 1:800 EAST LUGONIA AVENUE
Practice Address - Street 2:SUITE F
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2550
Practice Address - Country:US
Practice Address - Phone:909-793-6399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SAN BERNARDINO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-04
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB65059FOtherLAB
CAZZT11488FMedicaid
CAZZZ75903ZMedicare UPIN