MEDICARE: LAGUNA BEACH USD

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	30-66555	OTHER	CA	MADI-CAL

General Provider Information

NPI Number	:	1386791432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAGUNA BEACH USD

Provider Business Mailing Address
First Line	:	550 BLUMONT ST.
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-2356
Country	:	US
Telephone Number	:	949-497-7700
Fax Number	:	949-497-6021

Provider Business Practice Location Address
First Line	:	550 BLUMONT ST.
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-2356
Country	:	US
Telephone Number	:	949-497-7700
Fax Number	:	949-497-6021

Authorized Official
Title or Position	:	ASSISTANT SUPERINTENDENT OF INSTRUC
Name	:	DR. CHAD MABERY
Credential	:
Telephone Number	:	949-497-7700

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	05/12/2026

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Directions to “LAGUNA BEACH USD ” Practice Location

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