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Organization
CALIFORNIA STATE UNIVERSITY, SACRAMENTO STUDENT HEALTH CENTER
Active
Organization
CALIFORNIA STATE UNIVERSITY, SACRAMENTO STUDENT HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANNE MARIE HARRIS VAN DAHLEN (SENIOR ASSOCIATE VICE PRESIDENT)
(916) 278-1772
Entity
Organization
Contact information
Practice address
6000 J STREET, SACRAMENTO, CA 95819-6045
(916) 278-6035
Mailing address
6000 J STREET, SACRAMENTO, CA 95819-6045
(916) 278-6035
Taxonomy
Speciality
Code
Description
License number
State
261QS1000X
Student Health Clinic/Center
Primary
261846341
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1376659896
MEDI-CAL
CA
05
—
GR00090480
—
CA
Enumeration date
08/21/2006
Last updated
06/18/2024
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