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
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
Other
Enumeration date
09/19/2012
Last updated
09/19/2012
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