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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