Healthcare Provider Details

I. General information

NPI: 1215852066
Provider Name (Legal Business Name): ASU PREPARATORY ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 E UNIVERSITY DR STE 230
TEMPE AZ
85288-8402
US

IV. Provider business mailing address

1130 E UNIVERSITY DR STE 230
TEMPE AZ
85288-8402
US

V. Phone/Fax

Practice location:
  • Phone: 480-727-2435
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KRYSTLE ROSALES
Title or Position: ESS PROGRAM MANAGER
Credential:
Phone: 480-264-1929