Healthcare Provider Details

I. General information

NPI: 1043467228
Provider Name (Legal Business Name): LA UNIFIED SCHOOLS CHDP TEAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 SAN JULIAN ST 2
LOS ANGELES CA
90015-3142
US

IV. Provider business mailing address

1430 SAN JULIAN ST 2
LOS ANGELES CA
90015-3142
US

V. Phone/Fax

Practice location:
  • Phone: 213-765-2800
  • Fax: 213-765-3861
Mailing address:
  • Phone: 213-765-2800
  • Fax: 213-765-3861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number225347
License Number StateCA

VIII. Authorized Official

Name: DEBORAH SCHULTZ
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 213-765-2800