Provider Demographics
NPI:1326356783
Name:UNIVERSITY OF CALIFORNIA, SAN DIEGO, STUDENT HEALTH SERVICE
Entity Type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA, SAN DIEGO, STUDENT HEALTH SERVICE
Other - Org Name:UCSD SHS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF STUDENT HEALTH SERVICE
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMING-MAGIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MSPH
Authorized Official - Phone:858-822-0455
Mailing Address - Street 1:9500 GILMAN DR # MC0039
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-0039
Mailing Address - Country:US
Mailing Address - Phone:858-822-2096
Mailing Address - Fax:858-246-0256
Practice Address - Street 1:9500 GILMAN DR # MC0039
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0039
Practice Address - Country:US
Practice Address - Phone:858-822-2096
Practice Address - Fax:858-246-0256
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health