Healthcare Provider Details

I. General information

NPI: 1194602599
Provider Name (Legal Business Name): UPLAND UNIFIED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 W 18TH ST
UPLAND CA
91784-1682
US

IV. Provider business mailing address

245 W 18TH ST
UPLAND CA
91784-1682
US

V. Phone/Fax

Practice location:
  • Phone: 909-949-7770
  • Fax:
Mailing address:
  • Phone: 909-949-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARIO JAQUEZ
Title or Position: DIRECTOR OF SUPPORT SERVICES
Credential: ED
Phone: 909-949-7804