Provider Demographics
NPI:1619169414
Name:LITTLE LAKE CITY ELEMENTARY SCHOOL DISTRICT
Entity Type:Organization
Organization Name:LITTLE LAKE CITY ELEMENTARY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-868-8241
Mailing Address - Street 1:10515 PIONEER BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-3703
Mailing Address - Country:US
Mailing Address - Phone:562-868-8241
Mailing Address - Fax:562-868-1192
Practice Address - Street 1:10515 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-3703
Practice Address - Country:US
Practice Address - Phone:562-868-8241
Practice Address - Fax:562-868-1192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS1964717Medicaid