NPIMap

Organization Active NPI

Shasta Community College - Student Health Services

  • Student Health Clinic/Center
  • Redding, CA
National Provider Identifier
1033320726
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student Health Clinic/CenterTaxonomy code 261QS1000X
License
G45631 Issued in CA
Legal business name
SHASTA COMMUNITY COLLEGE - STUDENT HEALTH SERVICES
Practice address
11555 Old Oregon TRL
Redding, CA 96003-7692
Phone
(530) 242-7580
Fax
(530) 225-4968
NPI assigned
May 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Julian Fuentes, M.D.
Title
Contracted Physician
Phone
(530) 242-7580

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student Health Clinic/Center 261QS1000X G45631 CA Primary

Addresses

Primary practice location

11555 Old Oregon TRL
Redding, CA 96003-7692

Mailing address

11555 Old Oregon TRL
Redding, CA 96003-7692
Phone (530) 242-7580

National Provider Directory

National Provider Directory
Tax ID family
Shasta College Dental Hygiene Program2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

11555 Old Oregon Trl
Redding, CA 96003
Phone (530) 242-7580

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1033320726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11555 OLD OREGON TRL",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960037692",
            "telephone_number": "530-242-7580",
            "fax_number": "530-225-4968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11555 OLD OREGON TRL",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960037692",
            "telephone_number": "530-242-7580",
            "fax_number": "530-225-4968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHASTA COMMUNITY COLLEGE - STUDENT HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FUENTES",
        "authorized_official_first_name": "JULIAN",
        "authorized_official_title_or_position": "CONTRACTED PHYSICIAN",
        "authorized_official_telephone_number": "530-242-7580",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": "CA",
            "license": "G45631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redding, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.