Provider Demographics
NPI:1366422776
Name:CALIFORNIA STATE UNIVERSITY EAST BAY
Entity type:Organization
Organization Name:CALIFORNIA STATE UNIVERSITY EAST BAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR STUDENT HEALTH S
Authorized Official - Prefix:
Authorized Official - First Name:CATHLEEN
Authorized Official - Middle Name:U
Authorized Official - Last Name:COULMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-885-3639
Mailing Address - Street 1:25800 CARLOS BEE BLVD
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94542
Mailing Address - Country:US
Mailing Address - Phone:510-885-3735
Mailing Address - Fax:510-885-3230
Practice Address - Street 1:25800 CARLOS BEE BLVD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94542
Practice Address - Country:US
Practice Address - Phone:510-885-3735
Practice Address - Fax:510-885-3230
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALIFORNIA STATE UNIVERSITY EAST BAY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-20
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0089820Medicaid