Provider Demographics
NPI:1801098421
Name:HACIENDA LA PUENTE USD
Entity type:Organization
Organization Name:HACIENDA LA PUENTE USD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. SUPERINTENDENT, BUS. SERV.
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATSUMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-933-6526
Mailing Address - Street 1:455 GLENDORA AVE
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-4519
Mailing Address - Country:US
Mailing Address - Phone:626-933-6507
Mailing Address - Fax:626-855-8598
Practice Address - Street 1:455 GLENDORA AVE
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-4519
Practice Address - Country:US
Practice Address - Phone:626-933-6507
Practice Address - Fax:626-855-8598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS1973445Medicaid