Healthcare Provider Details

I. General information

NPI: 1740378397
Provider Name (Legal Business Name): SUNNYSIDE UNIFIED SCHOOL DISTRICT NO. 12
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2238 E GINTER RD
TUCSON AZ
85706-5806
US

IV. Provider business mailing address

2238 E GINTER RD
TUCSON AZ
85706-5806
US

V. Phone/Fax

Practice location:
  • Phone: 520-545-2137
  • Fax: 520-545-2120
Mailing address:
  • Phone: 520-545-2137
  • Fax: 520-545-2120

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: DR. ALAN L STORM
Title or Position: ASSISTANT SUPERINTENDENT OF STUDENT
Credential:
Phone: 520-545-2065