Provider Demographics
NPI:1841338191
Name:CALIFORNIA STATE UNIVERSITY, STANISLAUS STUDENT HEALTH CENTER
Entity type:Organization
Organization Name:CALIFORNIA STATE UNIVERSITY, STANISLAUS STUDENT HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:C
Authorized Official - Last Name:HENNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-667-3396
Mailing Address - Street 1:ONE UNIVERSITY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382
Mailing Address - Country:US
Mailing Address - Phone:209-667-3396
Mailing Address - Fax:209-667-3195
Practice Address - Street 1:ONE UNIVERSITY CIRCLE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382
Practice Address - Country:US
Practice Address - Phone:209-667-3396
Practice Address - Fax:209-667-3195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health