Provider Demographics
NPI:1447426036
Name:MESA COLLEGE STUDENT HEALTH SERVICES
Entity Type:Organization
Organization Name:MESA COLLEGE STUDENT HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-388-2774
Mailing Address - Street 1:7250 MESA COLLEGE DR # L-504
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-4902
Mailing Address - Country:US
Mailing Address - Phone:619-388-2774
Mailing Address - Fax:619-388-2853
Practice Address - Street 1:7250 MESA COLLEGE DR # L-504
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-4902
Practice Address - Country:US
Practice Address - Phone:619-388-2774
Practice Address - Fax:619-388-2853
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN DIEGO COMMUNITY COLLEGE DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8165261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center