Healthcare Provider Details

I. General information

NPI: 1285489690
Provider Name (Legal Business Name): SANTIAGO CHARTER MIDDLE SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 04/19/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 N RANCHO SANTIAGO BLVD
ORANGE CA
92869
US

IV. Provider business mailing address

515 N RANCHO SANTIAGO BLVD
ORANGE CA
92869
US

V. Phone/Fax

Practice location:
  • Phone: 714-997-6366
  • Fax:
Mailing address:
  • Phone: 714-997-6366
  • Fax: 714-532-4758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: DR. JIM D'AGOSTINO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 714-997-6366