Provider Demographics
NPI:1942659271
Name:SUNNYSIDE UNIFIED SCHOOL DISTRICT
Entity type:Organization
Organization Name:SUNNYSIDE UNIFIED SCHOOL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ATHLETIC TRAINER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:LATTA
Authorized Official - Suffix:
Authorized Official - Credentials:ATC/L
Authorized Official - Phone:520-405-1512
Mailing Address - Street 1:1725 E BILBY RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706-4430
Mailing Address - Country:US
Mailing Address - Phone:520-545-3000
Mailing Address - Fax:
Practice Address - Street 1:1725 E BILBY RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706-4430
Practice Address - Country:US
Practice Address - Phone:520-545-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0292261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health