Provider Demographics
NPI:1851177174
Name:DE ANZA COLLEGE STUDENT HEALTH SERVICES
Entity Type:Organization
Organization Name:DE ANZA COLLEGE STUDENT HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEAN, EOPS/CARE AND STUDENT DEVELOP
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBLEU-BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-864-8218
Mailing Address - Street 1:21250 STEVENS CREEK BLVD.
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-5973
Mailing Address - Country:US
Mailing Address - Phone:408-864-8732
Mailing Address - Fax:408-864-8983
Practice Address - Street 1:21250 STEVENS CREEK BLVD.
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-5973
Practice Address - Country:US
Practice Address - Phone:408-864-8732
Practice Address - Fax:408-864-8983
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOOTHILL-DEANZA COMM. COLLEGE DISTRI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health