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General NPI Number Information
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NPI Number | 1679231500
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Entity Type | Organization
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Legal Business Name | MORENO VALLEY HIGH SCHOOL
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Dates
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Enumeration Date | 12/08/2021
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 56 CAMINO GRANDE
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City | ANGEL FIRE
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State | NM
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Zip | 87710-8771
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Country | US
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Telephone | 575-377-3100
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Fax | 575-377-3100
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Provider Business Mailing Address
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Address Line | PO BOX 1037
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City | ANGEL FIRE
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State | NM
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Zip | 87710-1037
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Country | US
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Telephone | 575-377-3100
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | JILIANN WILLIAMS
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Credential |
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Telephone | 575-377-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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