Provider Demographics
NPI:1558407429
Name:SIERRA VISTA PUBLIC SCHOOLS
Entity Type:Organization
Organization Name:SIERRA VISTA PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAEZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-515-2930
Mailing Address - Street 1:5766 S RED TAIL LN
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85615-9224
Mailing Address - Country:US
Mailing Address - Phone:520-559-1326
Mailing Address - Fax:
Practice Address - Street 1:SIERRA VISTA MIDDLE SCHOOL
Practice Address - Street 2:1045 S LENZNER
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635
Practice Address - Country:US
Practice Address - Phone:520-515-2930
Practice Address - Fax:520-515-2941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170300000XOther Service ProvidersGenetic Counselor, MSGroup - Single Specialty