Provider Demographics
NPI:1013253822
Name:STUDENT HEALTH SERVICE, CALIFORNIA STATE UNIVERSITY CHICO
Entity Type:Organization
Organization Name:STUDENT HEALTH SERVICE, CALIFORNIA STATE UNIVERSITY CHICO
Other - Org Name:WELLCAT HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ANEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-898-3044
Mailing Address - Street 1:400 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95929-0777
Mailing Address - Country:US
Mailing Address - Phone:530-898-3044
Mailing Address - Fax:530-898-6731
Practice Address - Street 1:601 WARNER STR MEDICAL CLINIC FOOR 1
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95929-0777
Practice Address - Country:US
Practice Address - Phone:530-898-5241
Practice Address - Fax:530-898-4057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLE 2073390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty