=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801104617
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LA ACADEMIA DE ESTRELLAS CHARTER SCHOOL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2010
-----------------------------------------------------
Last Update Date | 09/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 SOUTH BECKLEY AVENUE
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75203-2610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-946-8908
-----------------------------------------------------
Fax | 214-946-8777
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 S BECKLEY AVE
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75203-2610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPED TEACHER
-----------------------------------------------------
Name | TINA THAO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-946-8908
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------