Basic Information
| Provider Information | |||||||||
| NPI: | 1861037954 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JURUPA UNIFIED SCHOOL DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3924 RIVERVIEW DR | ||||||||
| Address2: | |||||||||
| City: | JURUPA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925096611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513604175 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3924 RIVERVIEW DR | ||||||||
| Address2: | |||||||||
| City: | JURUPA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925096611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9514161572 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2019 | ||||||||
| LastUpdateDate: | 04/12/2022 | ||||||||
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| AuthorizedOfficialLastName: | CAMPOS | ||||||||
| AuthorizedOfficialFirstName: | JOSE | ||||||||
| AuthorizedOfficialMiddleName: | EDUARDO | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9513604175 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | JURUPA USD | ||||||||
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| NPICertificationDate: | 04/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 251300000X | Y | Agencies | Local Education Agency (LEA) |
No ID Information.