Provider Demographics
NPI:1871764175
Name:COUNTY OF SAN BERNARDINO
Entity type:Organization
Organization Name:COUNTY OF SAN BERNARDINO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR FISCAL TECH II
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:URISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-387-5959
Mailing Address - Street 1:157 WEST 5TH ST 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0451
Mailing Address - Country:US
Mailing Address - Phone:909-387-5902
Mailing Address - Fax:909-387-5685
Practice Address - Street 1:NORTH & SOUTH BOUND I-15
Practice Address - Street 2:@ ZZZ
Practice Address - City:BAKER
Practice Address - State:CA
Practice Address - Zip Code:92309
Practice Address - Country:US
Practice Address - Phone:909-387-5902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency