Healthcare Provider Details

I. General information

NPI: 1730205949
Provider Name (Legal Business Name): COUNTY OF MONO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 TWIN LAKES ROAD
BRIDGEPORT CA
93517
US

IV. Provider business mailing address

PO BOX 511
BRIDGEPORT CA
93517-0511
US

V. Phone/Fax

Practice location:
  • Phone: 760-932-5485
  • Fax: 760-932-2603
Mailing address:
  • Phone: 760-932-5485
  • Fax: 760-932-2603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. BRYAN BULLOCK
Title or Position: CHIEF
Credential:
Phone: 760-932-5485