Healthcare Provider Details

I. General information

NPI: 1326262759
Provider Name (Legal Business Name): LAGUNA DEPARTMENT OF EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

I-40 WEST, EXIT 114
LAGUNA NM
87026
US

IV. Provider business mailing address

PO BOX 207
LAGUNA NM
87026
US

V. Phone/Fax

Practice location:
  • Phone: 505-552-9200
  • Fax: 505-552-7294
Mailing address:
  • Phone: 505-552-6008
  • Fax: 505-552-6398

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: REBECCA MCKIE
Title or Position: ASSISTANT PRINCIPAL
Credential:
Phone: 505-552-9200