Provider Demographics
NPI:1144390618
Name:FONTANA UNIFIED SCHOOL DISTRICT
Entity Type:Organization
Organization Name:FONTANA UNIFIED SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODMAN-MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN,RN,PNP
Authorized Official - Phone:909-357-5000
Mailing Address - Street 1:9680 CITRUS AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-5571
Mailing Address - Country:US
Mailing Address - Phone:909-357-5000
Mailing Address - Fax:909-357-5281
Practice Address - Street 1:9680 CITRUS AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-5571
Practice Address - Country:US
Practice Address - Phone:909-357-5000
Practice Address - Fax:909-357-5281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASS3667710251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)