Provider Demographics
NPI:1053134221
Name:CALIFORNIA BAPTIST UNIVERSITY
Entity type:Organization
Organization Name:CALIFORNIA BAPTIST UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR MOBILE HEALTH
Authorized Official - Prefix:PROF
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:PITCHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD(C), MSN RN, PHN-
Authorized Official - Phone:951-552-8155
Mailing Address - Street 1:8432 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3297
Mailing Address - Country:US
Mailing Address - Phone:951-343-4702
Mailing Address - Fax:
Practice Address - Street 1:8432 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-3297
Practice Address - Country:US
Practice Address - Phone:951-343-4702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health