Organization
ETIWANDA ESD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWN JUDSON (SUPERINTENDENT)
(909) 899-2451
Entity
Organization
Contact information
Practice address
6061 EAST AVE, ETIWANDA, CA 91739-2218
(909) 899-2451
(909) 899-1235
Mailing address
3333 CONCOURS STE 4102, ONTARIO, CA 91764-6564
(909) 944-7798
(909) 481-7410
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SS3667702
MEDI-CAL
CA
Enumeration date
01/09/2007
Last updated
08/22/2020
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