NPIMap

Organization Active NPI

California State Polytechnic University

  • Student Health Clinic/Center
  • Pomona, CA
National Provider Identifier
1063694479
Registry record updated Nov 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student Health Clinic/CenterTaxonomy code 261QS1000X
License
306630 Issued in CA
Legal business name
CALIFORNIA STATE POLYTECHNIC UNIVERSITY
Practice address
3801 W Temple Ave
Pomona, CA 91768-2557
Phone
(909) 869-4000
NPI assigned
Nov 28, 2007
Last updated
Nov 28, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2007

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

Authorized official

Name
Kay Vierra
Title
Interim Director
Phone
(909) 869-2760

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student Health Clinic/Center 261QS1000X 306630 CA Primary

Addresses

Primary practice location

3801 W Temple Ave
Pomona, CA 91768-2557

Mailing address

3801 W Temple Ave
Pomona, CA 91768-2557
Phone (909) 869-4000

National Provider Directory

National Provider Directory
Tax ID family
Student Health Services2 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.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1196208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196208000000",
    "number": "1063694479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 W TEMPLE AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917682557",
            "telephone_number": "909-869-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 W TEMPLE AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917682557",
            "telephone_number": "909-869-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALIFORNIA STATE POLYTECHNIC UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-28",
        "last_updated": "2007-11-28",
        "status": "A",
        "authorized_official_last_name": "VIERRA",
        "authorized_official_first_name": "KAY",
        "authorized_official_title_or_position": "INTERIM DIRECTOR",
        "authorized_official_telephone_number": "909-869-2760"
    },
    "taxonomies": [
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": "CA",
            "license": "306630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2007; 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.