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Organization
CALIFORNIA STATE UNIVERSITY FRESNO ATHLETIC CORPORATION
Active
Organization
CALIFORNIA STATE UNIVERSITY FRESNO ATHLETIC CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETSY MOSHER (DIRECTOR OF ATHLETICS)
(559) 278-4905
Entity
Organization
Contact information
Practice address
1620 E BULLDOG LN, FRESNO, CA 93740-0001
(559) 278-4170
(559) 278-8355
Mailing address
1620 E BULLDOG LN, FRESNO, CA 93740-0001
(559) 278-4170
(559) 278-8355
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
NULL
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
207X00000X
Orthopaedic Surgery Physician
—
NULL
207X00000X
Orthopaedic Surgery Physician
—
—
Other
Enumeration date
09/19/2012
Last updated
09/19/2012
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