MEDICARE: BERRYESSA UNION ELEMENTARY SCHOOL DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	43-69377	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1154479814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERRYESSA UNION ELEMENTARY SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	2777 DEL MONTE ST
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-3811
Country	:	US
Telephone Number	:	916-375-1707
Fax Number	:

Provider Business Practice Location Address
First Line	:	1376 PIEDMONT RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95132-2498
Country	:	US
Telephone Number	:	408-923-1830
Fax Number	:

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	PATRICIA STELWAGON
Credential	:
Telephone Number	:	408-923-1830

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	08/22/2020

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Directions to “BERRYESSA UNION ELEMENTARY SCHOOL DISTRICT ” Practice Location

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