Healthcare Provider Details

I. General information

NPI: 1598889214
Provider Name (Legal Business Name): CAJON VALLEY UNION ELEMENTARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 ROANOKE RD
EL CAJON CA
92020-4015
US

IV. Provider business mailing address

189 ROANOKE RD PO BOX 1007
EL CAJON CA
92020-4015
US

V. Phone/Fax

Practice location:
  • Phone: 619-588-3265
  • Fax: 619-588-3673
Mailing address:
  • Phone: 619-588-3265
  • Fax: 619-588-3673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. GEORGE W OETKEN
Title or Position: ASST. SUPERINTENDENT
Credential:
Phone: 619-588-3060