Healthcare Provider Details

I. General information

NPI: 1588003693
Provider Name (Legal Business Name): JUSTIN SIENA HIGH SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 1ST ST
NAPA CA
94559-2239
US

IV. Provider business mailing address

2310 1ST ST
NAPA CA
94559-2239
US

V. Phone/Fax

Practice location:
  • Phone: 707-255-1855
  • Fax: 707-255-5621
Mailing address:
  • Phone: 707-255-1855
  • Fax: 707-255-5621

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: GRACE MANZO
Title or Position: BILLING SPECIALIST
Credential:
Phone: 707-255-1855