MEDICARE: EL SEGUNDO UNIFIED SCHOOL DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19-64535	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1336297647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL SEGUNDO UNIFIED SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	2777 DEL MONTE ST
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-3811
Country	:	US
Telephone Number	:	916-375-1707
Fax Number	:

Provider Business Practice Location Address
First Line	:	641 SHELDON ST
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-3036
Country	:	US
Telephone Number	:	310-615-2650
Fax Number	:

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	BRUCE AULD
Credential	:
Telephone Number	:	310-615-2650

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	08/22/2020

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Directions to “EL SEGUNDO UNIFIED SCHOOL DISTRICT ” Practice Location

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