Healthcare Provider Details

I. General information

NPI: 1588794259
Provider Name (Legal Business Name): DULCE INDEPENDENT SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 HAWK DRIVE
DULCE NM
87528-0547
US

IV. Provider business mailing address

113 HAWK DRIVE PO BOX 547
DULCE NM
87528-0547
US

V. Phone/Fax

Practice location:
  • Phone: 505-759-2913
  • Fax:
Mailing address:
  • Phone: 505-759-2951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number01-600729-00-8
License Number StateNM

VIII. Authorized Official

Name: MS. RAMONA LUCERO
Title or Position: MEDICAID COORDINATOR
Credential:
Phone: 505-759-2954