Provider Demographics
NPI:1194602599
Name:UPLAND UNIFIED
Entity type:Organization
Organization Name:UPLAND UNIFIED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SUPPORT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:JAQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:ED
Authorized Official - Phone:909-949-7804
Mailing Address - Street 1:245 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-1682
Mailing Address - Country:US
Mailing Address - Phone:909-949-7770
Mailing Address - Fax:
Practice Address - Street 1:245 W 18TH ST
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91784-1682
Practice Address - Country:US
Practice Address - Phone:909-949-7770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty