Provider Demographics
NPI:1962958561
Name:UNIVERSITY OF SAN DIEGO STUDENT HEALTH CENTER
Entity type:Organization
Organization Name:UNIVERSITY OF SAN DIEGO STUDENT HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:STURGIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-260-7643
Mailing Address - Street 1:5998 ALCALA PARK
Mailing Address - Street 2:MAHER 140
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2492
Mailing Address - Country:US
Mailing Address - Phone:619-260-4595
Mailing Address - Fax:619-260-2375
Practice Address - Street 1:5998 ALCALA PARK
Practice Address - Street 2:MAHER 140
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-8001
Practice Address - Country:US
Practice Address - Phone:619-260-4595
Practice Address - Fax:619-260-2375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherEIN