Healthcare Provider Details

I. General information

NPI: 1912907668
Provider Name (Legal Business Name): CITY OF COALINGA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W ELM AVE
COALINGA CA
93210
US

IV. Provider business mailing address

PO BOX 45159
SAN FRANCISCO CA
94145-0159
US

V. Phone/Fax

Practice location:
  • Phone: 559-935-1652
  • Fax:
Mailing address:
  • Phone: 916-381-6552
  • Fax: 916-471-5107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DWAYNE GABRIEL
Title or Position: FIRE CHIEF
Credential:
Phone: 559-935-1652