Mt. San Antonio College

Primary specialty

Student Health Clinic/CenterTaxonomy code 261QS1000X

Legal business name

MT. SAN ANTONIO COLLEGE

Practice address

1100 N Grand Ave
67B
Walnut, CA 91789-1341

Phone

(909) 594-5611

Fax

(909) 468-3997

NPI assigned

Jan 4, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Sandra Samples, RN

Title

Director, Student Health Services

Phone

(909) 594-5611

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1199404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199404800000",
    "number": "1962687269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 N GRAND AVE",
            "address_2": "67B",
            "city": "WALNUT",
            "state": "CA",
            "postal_code": "917891341",
            "telephone_number": "909-591-5611",
            "fax_number": "909-468-3997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 N GRAND AVE",
            "address_2": "67B",
            "city": "WALNUT",
            "state": "CA",
            "postal_code": "917891341",
            "telephone_number": "909-594-5611",
            "fax_number": "909-468-3997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT. SAN ANTONIO COLLEGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-04",
        "last_updated": "2008-01-04",
        "status": "A",
        "authorized_official_last_name": "SAMPLES",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "DIRECTOR, STUDENT HEALTH SERVICES",
        "authorized_official_telephone_number": "909-594-5611",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Student Health Clinic/Center in Walnut, CA
• Providers in Walnut, 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 Jan 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.