Healthcare Provider Details

I. General information

NPI: 1952211708
Provider Name (Legal Business Name): CENTRALIA ELEMENTARY SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7770 CAMELLIA DR
BUENA PARK CA
90620-2152
US

IV. Provider business mailing address

7770 CAMELLIA DR
BUENA PARK CA
90620-2152
US

V. Phone/Fax

Practice location:
  • Phone: 714-228-3240
  • Fax:
Mailing address:
  • Phone: 714-228-3240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DORIS ALICIA KUBASEK
Title or Position: SCHOOL PSYCHOLOGIST
Credential: MAE., PPS
Phone: 323-535-1793