Organization
SAN JOSE STATE UNIVERSITY STUDENT HEALTH CENTER
Active
Parent organization
CALIFORNIA STATE UNIVERSITY
Organization subpart
Yes
Provider details
NPI number
Legal business name
CALIFORNIA STATE UNIVERSITY
Authorized official
DR. CECILIA MANIBO M.D. (MEDICAL CHIEF OF STAFF)
(408) 924-6140
Entity
Organization
Contact information
Practice address
1 WASHINGTON SQ, SAN JOSE, CA 95192-0037
(408) 924-6120
(408) 924-7786
Mailing address
1 WASHINGTON SQ, SAN JOSE, CA 95192-0037
(408) 924-6120
(408) 924-7786
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GR0051700
MEDI-CAL PROVIDER NUMBER
CA
Enumeration date
12/07/2007
Last updated
12/07/2007
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