Healthcare Provider Details

I. General information

NPI: 1154321495
Provider Name (Legal Business Name): LAKESHORE FIRE PROT DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14815 OLYMPIC DR
CLEARLAKE CA
95422-9522
US

IV. Provider business mailing address

14815 OLYMPIC DRIVE
CLEARLAKE CA
95422
US

V. Phone/Fax

Practice location:
  • Phone: 707-994-2170
  • Fax:
Mailing address:
  • Phone: 707-994-2170
  • Fax: 707-994-4861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WILLIAM SAPETA
Title or Position: FIRE CHIEF
Credential:
Phone: 707-994-2170