Healthcare Provider Details

I. General information

NPI: 1891864153
Provider Name (Legal Business Name): PIMA COUNTY AMPHITHEATER SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 WEST WETMORE ROAD ATTN STUDENT SERVICES
TUCSON AZ
85705-1547
US

IV. Provider business mailing address

701 WEST WETMORE ROAD ATTN STUDENT SERVICES
TUCSON AZ
85705-1547
US

V. Phone/Fax

Practice location:
  • Phone: 520-696-5095
  • Fax: 520-696-5067
Mailing address:
  • Phone: 520-696-5095
  • Fax: 520-696-5067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License NumberCTDS100210000
License Number StateAZ

VIII. Authorized Official

Name: MS. PAMELA FENSTAMAKER
Title or Position: ASSISTANT DIRECTOR SPECIAL EDUCATIO
Credential: MA
Phone: 520-696-5095