=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588913503
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOS ANGELES UNIFIED SCHOOL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2012
-----------------------------------------------------
Last Update Date | 09/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5435 VESPER AVE
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91411-3738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-267-5900
-----------------------------------------------------
Fax | 818-909-7274
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5435 VESPER AVE
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91411-3738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-267-5900
-----------------------------------------------------
Fax | 818-909-7274
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIC SOCIAL WORKER
-----------------------------------------------------
Name | MS. MARIA ISABEL CASTANEDA
-----------------------------------------------------
Credential | MSW
-----------------------------------------------------
Telephone | 818-267-5900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | ASW28001
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------