| Organization Name: | CAL POLY UNIVERSITY |
| NPI Number: | 1033410113 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KAY VIERRA (DIRECTOR) |
| Mailing Address: | 3801 W Temple Ave #46 Pomona |
| State: | CA US |
| Postal Code: | 917682557 |
| Phone Number: | 9098694222 |
| Fax Number: | 9098694561 |
| NPI Enumeration Date: | 11/05/2010 |
| NPI Last Update Date: | 11/05/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | 261QOOOX |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |