1558407429 NPI number — SIERRA VISTA PUBLIC SCHOOLS

Table of content: CHAD MAATMAN OTR/L (NPI 1114378338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558407429 NPI number — SIERRA VISTA PUBLIC SCHOOLS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIERRA VISTA PUBLIC SCHOOLS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558407429
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5766 S RED TAIL LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEREFORD
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85615-9224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-559-1326
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SIERRA VISTA MIDDLE SCHOOL
Provider Second Line Business Practice Location Address:
1045 S LENZNER
Provider Business Practice Location Address City Name:
SIERRA VISTA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-515-2930
Provider Business Practice Location Address Fax Number:
520-515-2941
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAEZA
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
COUNSELOR
Authorized Official Telephone Number:
520-515-2930

Provider Taxonomy Codes

  • Taxonomy code: 170300000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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