Provider Demographics
NPI:1073645339
Name:LUCIA MAR UNIFIED SCHOOL DISTRICT
Entity Type:Organization
Organization Name:LUCIA MAR UNIFIED SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-474-3000
Mailing Address - Street 1:602 ORCHARD AVE
Mailing Address - Street 2:BUILDING F
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-4097
Mailing Address - Country:US
Mailing Address - Phone:805-474-3000
Mailing Address - Fax:805-473-1587
Practice Address - Street 1:602 ORCHARD AVE
Practice Address - Street 2:BUILDING F
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-4097
Practice Address - Country:US
Practice Address - Phone:805-474-3000
Practice Address - Fax:805-473-1587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS4068759Medicaid