Provider Demographics
NPI:1497044598
Name:KING-CHAVEZ PRIMARY ACADEMY
Entity Type:Organization
Organization Name:KING-CHAVEZ PRIMARY ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-525-7320
Mailing Address - Street 1:415 31ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-4236
Mailing Address - Country:US
Mailing Address - Phone:619-525-7320
Mailing Address - Fax:619-696-7459
Practice Address - Street 1:415 31ST ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-4236
Practice Address - Country:US
Practice Address - Phone:619-525-7320
Practice Address - Fax:619-696-7459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6040190OtherCDS CODE