Healthcare Provider Details

I. General information

NPI: 1679570980
Provider Name (Legal Business Name): LOS ANGELES UNIFIED SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 W 97TH ST
LOS ANGELES CA
90003-3968
US

IV. Provider business mailing address

333 S BEAUDRY AVE SHHS - COST RECOVERY 29-216-02
LOS ANGELES CA
90017-1466
US

V. Phone/Fax

Practice location:
  • Phone: 213-241-0558
  • Fax: 213-241-8458
Mailing address:
  • Phone: 213-241-0558
  • Fax: 213-241-8458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberSS1964733
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS1964733
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberSS1964733
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberSS1964733
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberSS1964733
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberSS1964733
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberSS1964733
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberSS1964733
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSS1964733
License Number StateCA
# 11
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License NumberSS1964733
License Number StateCA
# 12
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberSS1964733
License Number StateCA
# 13
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0315
License Number StateCA
# 14
Primary TaxonomyN
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License NumberSS1964733
License Number StateCA

VIII. Authorized Official

Name: JOHN DICECCO
Title or Position: DIRECTOR
Credential:
Phone: 213-241-3846