Healthcare Provider Details

I. General information

NPI: 1558489609
Provider Name (Legal Business Name): AVENAL DISTRICT AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 N 3RD AVE
AVENAL CA
93204-1054
US

IV. Provider business mailing address

PO BOX 370 709 N. THIRD ST.
AVENAL CA
93204-1054
US

V. Phone/Fax

Practice location:
  • Phone: 559-386-2211
  • Fax: 559-386-2212
Mailing address:
  • Phone: 559-386-2211
  • Fax: 559-386-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BLAYNE SANDERS
Title or Position: BOARD OF DIRECTORS
Credential:
Phone: 559-386-2211