Healthcare Provider Details

I. General information

NPI: 1114161510
Provider Name (Legal Business Name): DULCE INDEPENDENT SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 HAWKS DR
DULCE NM
87528-0547
US

IV. Provider business mailing address

PO BOX 547
DULCE NM
87528-0547
US

V. Phone/Fax

Practice location:
  • Phone: 575-759-2924
  • Fax: 575-759-1349
Mailing address:
  • Phone: 575-759-2924
  • Fax: 575-759-1349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RALPH FRIEDLY
Title or Position: SUPERINTENDENT OF SCHOOLS
Credential:
Phone: 575-759-2904