Provider Demographics
NPI:1912116385
Name:CALIFORNIA STATE UNIVERSITY BAKERSFIELD STUDENT HEALTH SERVICES
Entity Type:Organization
Organization Name:CALIFORNIA STATE UNIVERSITY BAKERSFIELD STUDENT HEALTH SERVICES
Other - Org Name:CALIFORNIA STATE UNIVERSITY BAKERSFIELD, ANTELOPE VALLEY CAMPUS
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRONE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, ANP
Authorized Official - Phone:661-654-2394
Mailing Address - Street 1:9001 STOCKDALE HWY
Mailing Address - Street 2:28HC
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-1022
Mailing Address - Country:US
Mailing Address - Phone:661-654-2394
Mailing Address - Fax:661-654-3301
Practice Address - Street 1:9001 STOCKDALE HWY
Practice Address - Street 2:28HC
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-1022
Practice Address - Country:US
Practice Address - Phone:661-654-2394
Practice Address - Fax:661-654-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health