Provider Demographics
NPI:1073018016
Name:MT. DIABLO UNIFIED SCHOOL DISTRICT
Entity Type:Organization
Organization Name:MT. DIABLO UNIFIED SCHOOL DISTRICT
Other - Org Name:SUNRISE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPECIAL EDUCATION ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:POZOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-682-8000
Mailing Address - Street 1:1861 SILVERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-1352
Mailing Address - Country:US
Mailing Address - Phone:925-687-0202
Mailing Address - Fax:
Practice Address - Street 1:1861 SILVERWOOD DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519
Practice Address - Country:US
Practice Address - Phone:925-687-0202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MT. DIABLO UNIFIED SCHOOL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-29
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS0761754Medicaid