Provider Demographics
NPI:1487690038
Name:SAN ANTONIO INDEPENDENT SCHOOL DISTRICT
Entity type:Organization
Organization Name:SAN ANTONIO INDEPENDENT SCHOOL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL ED. ASSISTANT COACH
Authorized Official - Prefix:MISS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:VICTORIA
Authorized Official - Suffix:
Authorized Official - Credentials:RKT
Authorized Official - Phone:210-653-4672
Mailing Address - Street 1:6526 ROBIN FRST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78239-3220
Mailing Address - Country:US
Mailing Address - Phone:210-653-4672
Mailing Address - Fax:
Practice Address - Street 1:6526 ROBIN FOREST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78239-3220
Practice Address - Country:US
Practice Address - Phone:210-653-4672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1714251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare