Healthcare Provider Details

I. General information

NPI: 1003115544
Provider Name (Legal Business Name): LOS ANGELES UNIFIED SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 BALBOA BLVD
VAN NUYS CA
91406-5529
US

IV. Provider business mailing address

333 S. BEAUDRY AVE SMH, FLOOR 29
LOS ANGELES CA
90017-1466
US

V. Phone/Fax

Practice location:
  • Phone: 818-758-2300
  • Fax: 818-996-9850
Mailing address:
  • Phone: 818-997-2640
  • Fax: 818-996-9850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MARGARITA BOBE
Title or Position: MANAGER
Credential:
Phone: 213-241-0558