Healthcare Provider Details

I. General information

NPI: 1487659413
Provider Name (Legal Business Name): CITY OF AVALON DIRECTOR OF FINANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 AVALON CANYON DR
AVALON CA
90704
US

IV. Provider business mailing address

PO BOX 269110
SACRAMENTO CA
95826-9110
US

V. Phone/Fax

Practice location:
  • Phone: 310-510-0203
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL KRUG
Title or Position: FIRE CHIEF
Credential:
Phone: 310-510-0203