=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619169414
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LITTLE LAKE CITY ELEMENTARY SCHOOL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2007
-----------------------------------------------------
Last Update Date | 06/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10515 PIONEER BLVD
-----------------------------------------------------
City | SANTA FE SPRINGS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90670-3703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-868-8241
-----------------------------------------------------
Fax | 562-868-1192
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10515 PIONEER BLVD
-----------------------------------------------------
City | SANTA FE SPRINGS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90670-3703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-868-8241
-----------------------------------------------------
Fax | 562-868-1192
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASST. SUPERINTENDENT
-----------------------------------------------------
Name | MARTHA MAYA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 562-868-8241
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------