MEDICARE: WESTMINSTER SD

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	SS3066746	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1780735233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTMINSTER SD

Provider Business Mailing Address
First Line	:	3333 CONCOURS
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91764-4875
Country	:	US
Telephone Number	:	909-944-7798
Fax Number	:	909-481-7410

Provider Business Practice Location Address
First Line	:	14121 CEDARWOOD ST
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-4437
Country	:	US
Telephone Number	:	714-894-7311
Fax Number	:

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	ROBERTA MAHLER
Credential	:
Telephone Number	:	714-894-7311

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	08/22/2020

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Directions to “WESTMINSTER SD ” Practice Location

Language	Start Address	Practice Location

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