Healthcare Provider Details

I. General information

NPI: 1235287822
Provider Name (Legal Business Name): ST. DAVID UNIFIED SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 E PATTON ST
SAINT DAVID AZ
85630-6207
US

IV. Provider business mailing address

PO BOX 70
SAINT DAVID AZ
85630-0070
US

V. Phone/Fax

Practice location:
  • Phone: 520-720-4492
  • Fax: 520-720-4783
Mailing address:
  • Phone: 520-720-4492
  • Fax: 520-720-4783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateAZ

VIII. Authorized Official

Name: MRS. VICKIE BRADFORD
Title or Position: BUSINESS MANAGER
Credential:
Phone: 520-720-4781