Healthcare Provider Details

I. General information

NPI: 1043365398
Provider Name (Legal Business Name): RIO RANCHO PUBLIC SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LASER DR NE
RIO RANCHO NM
87124-4517
US

IV. Provider business mailing address

500 LASER DR NE
RIO RANCHO NM
87124-4517
US

V. Phone/Fax

Practice location:
  • Phone: 505-896-0667
  • Fax: 505-994-4609
Mailing address:
  • Phone: 505-896-0667
  • Fax: 505-994-4609

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: MS. LORRAINE TRUJILLO
Title or Position: MEDICAID DATA SPECIALIST
Credential:
Phone: 505-896-0667