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NPI Code Detail

MEDICARE: SYCUAN TRIBAL GOVERNMENT

MEDICARE: SYCUAN TRIBAL GOVERNMENT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13416L0300XLand Ambulance1570CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043218191
Entity Type Code : Organization
Provider Name (Legal Business Name) : SYCUAN TRIBAL GOVERNMENT
Provider Business Mailing Address
First Line : 2 KWAAYPAAY CT
Second Line :
City : EL CAJON
State : CA
Zip : 92019-1832
Country : US
Telephone Number : 619-445-4564
Fax Number : 619-445-9764
Provider Business Practice Location Address
First Line : 4921 DEHESA RD
Second Line :
City : EL CAJON
State : CA
Zip : 92019-2929
Country : US
Telephone Number : 619-445-0707
Fax Number : 619-445-0901
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MAURICE SMITH
Credential :
Telephone Number : 619-445-0707
Provider Enumeration Date : 07/12/2005
Last Update Date : 02/13/2026

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Directions to “SYCUAN TRIBAL GOVERNMENT ” Practice Location

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