California Polytechnic State University at San Luis Obispo

Primary specialty

Student Health Clinic/CenterTaxonomy code 261QS1000X

License

RN 348161 Issued in CA

Legal business name

CALIFORNIA POLYTECHNIC STATE UNIVERSITY AT SAN LUIS OBISPO

Practice address

1 Grand Ave
San Luis Obispo, CA 93407-9000

Phone

(805) 756-1211

NPI assigned

Dec 14, 2006

Organization subpart

No

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

Authorized official

Name

Tina Hadaway-Mellis

Title

Avp for Student Affairs Health

Phone

(805) 756-5206

Specialties & licenses 1

Addresses

Tax ID family

California Polytechnic State University2 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.

• Student Health Service Pharmacy

  • Clinic Pharmacy
  • San Luis Obispo, CA
  • NPI 1578694675
  NPD tax ID

Locations

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788307200000",
    "number": "1720140288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GRAND AVE",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934079000",
            "telephone_number": "805-756-1211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GRAND AVE",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934079000",
            "telephone_number": "805-756-1211"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Maritime Academy Dr",
            "address_purpose": "LOCATION",
            "city": "Vallejo",
            "state": "CA",
            "postal_code": "945908181",
            "country_code": "US",
            "telephone_number": "707-654-1170",
            "fax_number": "707-654-1171",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CALIFORNIA POLYTECHNIC STATE UNIVERSITY AT SAN LUIS OBISPO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2026-09-02",
        "certification_date": "2026-09-02",
        "status": "A",
        "authorized_official_last_name": "HADAWAY-MELLIS",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "AVP FOR STUDENT AFFAIRS HEALTH",
        "authorized_official_telephone_number": "805-756-5206"
    },
    "taxonomies": [
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": "CA",
            "license": "RN 348161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• California Dermatology Institute PC
• California Medical Surgery Center LLC
• California Men'S Colony Hospital
• California Neurohealth
• California Polytechnic State University
• California Polytechnic State University at San Luis Obispo
• California Retina Consultants
• California Wellness Center
• Katie Callahan
• Chandra Calloway

• Student Health Clinic/Center in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Student Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2026; 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.