Provider Demographics
NPI:1467546275
Name:PLACENTIA YORBA LINDA UNIFIED SCHOOL DISTRICT
Entity Type:Organization
Organization Name:PLACENTIA YORBA LINDA UNIFIED SCHOOL DISTRICT
Other - Org Name:CHILD HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, S.E.L.P.A.
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AKERS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:714-985-8659
Mailing Address - Street 1:3232 TOPAZ LN
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-2609
Mailing Address - Country:US
Mailing Address - Phone:714-579-1548
Mailing Address - Fax:714-528-7963
Practice Address - Street 1:3232 TOPAZ LN
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-2609
Practice Address - Country:US
Practice Address - Phone:714-579-1548
Practice Address - Fax:714-528-7963
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLACENTIA YORBA LINDA UNIFIED SCHOOL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA255249261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS 3066647Medicaid
CACH02068Medicaid