Provider Demographics
NPI:1962553248
Name:EASTSIDE ESD
Entity type:Organization
Organization Name:EASTSIDE ESD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-952-1200
Mailing Address - Street 1:3333 CONCOURS
Mailing Address - Street 2:SUITE 4102
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-4875
Mailing Address - Country:US
Mailing Address - Phone:909-944-7798
Mailing Address - Fax:909-481-7410
Practice Address - Street 1:45006 30TH ST E
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-2815
Practice Address - Country:US
Practice Address - Phone:661-952-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
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
CASS1964477OtherMEDI-CAL