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General NPI Number Information
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NPI Number | 1063790459
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Entity Type | Organization
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Legal Business Name | MARTIN LUTHER KING, JR TECHNOLOGY ACADEMY
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Dates
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Enumeration Date | 08/02/2011
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Last Update Date | 08/24/2011
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Provider Practice Location Address
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Address Line | 3051 FAIRFIELD ST
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City | SACRAMENTO
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State | CA
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Zip | 95815-1132
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Country | US
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Telephone | 916-566-3490
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Fax |
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Provider Business Mailing Address
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Address Line | 3051 FAIRFIELD ST
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City | SACRAMENTO
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State | CA
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Zip | 95815-1132
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Country | US
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Telephone | 916-566-3490
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | DANNY WILLIAMS
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Credential | TEACHER
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Telephone | 916-566-3490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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