Healthcare Provider Details

I. General information

NPI: 1033260377
Provider Name (Legal Business Name): PALO VERDE USD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 N 1ST ST
BLYTHE CA
92225-1703
US

IV. Provider business mailing address

3333 CONCOURS
ONTARIO CA
91764-4875
US

V. Phone/Fax

Practice location:
  • Phone: 760-922-4164
  • Fax:
Mailing address:
  • Phone: 909-944-7798
  • Fax: 909-481-7410

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: ALAN JENSEN
Title or Position: SUPERINTENDENT
Credential:
Phone: 760-922-4164