Healthcare Provider Details

I. General information

NPI: 1538364062
Provider Name (Legal Business Name): MESA VISTA CONSOLIDATED SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 A HWY 554
EL RITO NM
87530-0006
US

IV. Provider business mailing address

PO BOX 6
EL RITO NM
87530-0006
US

V. Phone/Fax

Practice location:
  • Phone: 505-581-4504
  • Fax:
Mailing address:
  • Phone: 505-581-4504
  • Fax:

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: ROBERT ARCHULETA
Title or Position: SUPERINTENDENT
Credential:
Phone: 505-581-4504