Healthcare Provider Details

I. General information

NPI: 1891981569
Provider Name (Legal Business Name): PLANADA ELEMENTARY SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 09/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 SO. PLAINSBURG ROAD
PLANADA CA
95365-0236
US

IV. Provider business mailing address

PO BOX 236 161 S. PLAINSBURG ROAD
PLANADA CA
95365-0236
US

V. Phone/Fax

Practice location:
  • Phone: 209-382-0756
  • Fax: 209-382-1750
Mailing address:
  • Phone: 209-382-0756
  • Fax: 209-382-1750

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: MRS. MARY LOURENCO
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 209-382-0756