Provider Demographics
NPI:1689892895
Name:FULLERTON ELEMENTARY SCHOOL DISTRICT
Entity Type:Organization
Organization Name:FULLERTON ELEMENTARY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:714-447-7501
Mailing Address - Street 1:1401 W VALENCIA DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-3938
Mailing Address - Country:US
Mailing Address - Phone:714-447-7400
Mailing Address - Fax:714-447-7793
Practice Address - Street 1:1401 W VALENCIA DR
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-3938
Practice Address - Country:US
Practice Address - Phone:714-447-7400
Practice Address - Fax:714-447-7793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS3066506Medicaid