=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932450681
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAN BERNARDINO COUNTY SCHOOLS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2012
-----------------------------------------------------
Last Update Date | 09/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 144 N MOUNTAIN VIEW AVE
-----------------------------------------------------
City | SAN BERNARDINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92408-1015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-252-4507
-----------------------------------------------------
Fax | 909-252-4533
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 144 N MOUNTAIN VIEW AVE
-----------------------------------------------------
City | SAN BERNARDINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92408-1015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-252-4507
-----------------------------------------------------
Fax | 909-252-4533
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | ANITA RUESTERHOLTZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 909-252-4507
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------