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General NPI Number Information
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NPI Number | 1205988102
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Entity Type | Organization
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Legal Business Name | ESPANOLA PUBLIC SCHOOLS
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 714 CALLE DON DIEGO
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City | ESPANOLA
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State | NM
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Zip | 87532-3414
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Country | US
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Telephone | 505-367-3342
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Fax |
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Provider Business Mailing Address
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Address Line | 714 CALLE DON DIEGO
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City | ESPANOLA
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State | NM
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Zip | 87532-3414
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Country | US
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Telephone | 505-367-3342
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Fax |
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Authorized Official
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Title or Position | MEDICAID MANAGER
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Name | MRS. ANNA MARIE MARTINEZ
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Credential |
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Telephone | 505-367-3342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number | 34659714
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License Number State | NM
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