Basic Information
| Provider Information | |||||||||
| NPI: | 1609307925 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNION AVE ELEMENTARY SCHOOL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900171908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134817464 | ||||||||
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| Practice Location | |||||||||
| Address1: | 150 S BURLINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900572506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134831345 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2017 | ||||||||
| LastUpdateDate: | 04/07/2021 | ||||||||
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| AuthorizedOfficialLastName: | VALENZUELA | ||||||||
| AuthorizedOfficialFirstName: | TEDDIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 2134817464 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | AMANECER COMMUNITY COUNSELING SERVICE | ||||||||
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| NPICertificationDate: | 04/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251300000X | CA | Y | Agencies | Local Education Agency (LEA) |
No ID Information.