Healthcare Provider Details

I. General information

NPI: 1104806926
Provider Name (Legal Business Name): OCOTILLO WELLS FIRE RESCUE DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 HIGHWAY 78
BORREGO SPRINGS CA
92004-5612
US

IV. Provider business mailing address

PO BOX 269110
SACRAMENTO CA
95826-9110
US

V. Phone/Fax

Practice location:
  • Phone: 760-767-7430
  • 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: CHARLES T GANN
Title or Position: FIRE CHIEF
Credential:
Phone: 760-767-7430