Provider Demographics
NPI:1669659280
Name:ANAHEIM UNION HIGH SCHOOL DISTRICT CHDP CLINIC
Entity Type:Organization
Organization Name:ANAHEIM UNION HIGH SCHOOL DISTRICT CHDP CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SUPERINTENDENT BUSINESS
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:POOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-999-3555
Mailing Address - Street 1:1800 W BALL RD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-5516
Mailing Address - Country:US
Mailing Address - Phone:714-999-0814
Mailing Address - Fax:714-999-6938
Practice Address - Street 1:1800 W BALL RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-5516
Practice Address - Country:US
Practice Address - Phone:714-999-0814
Practice Address - Fax:714-999-6938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS3066431Medicaid
CA1144368093OtherNPI