Provider Demographics
NPI:1407189525
Name:SAN BERNARDINO VALLEY COLLEGE, STUDENT HEALTH SERVICES
Entity Type:Organization
Organization Name:SAN BERNARDINO VALLEY COLLEGE, STUDENT HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR STUDENT HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:AKERS
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:909-384-4495
Mailing Address - Street 1:701 S MOUNT VERNON AVE
Mailing Address - Street 2:STUDENT HEALTH SERVICES
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-2705
Mailing Address - Country:US
Mailing Address - Phone:909-038-4449
Mailing Address - Fax:909-888-2357
Practice Address - Street 1:701 S MOUNT VERNON AVE
Practice Address - Street 2:STUDENT HEALTH SERVICES
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-2705
Practice Address - Country:US
Practice Address - Phone:909-038-4449
Practice Address - Fax:909-888-2357
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN BERNARDINO COMMUNITY COLLEGE DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA280062261QH0100X, 261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service