Healthcare Provider Details

I. General information

NPI: 1730227737
Provider Name (Legal Business Name): CREST FOREST FIRE PROTECTION DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23407 CREST FOREST DR
CRESTLINE CA
92325
US

IV. Provider business mailing address

PO BOX 3220
CRESTLINE CA
92325-3220
US

V. Phone/Fax

Practice location:
  • Phone: 909-338-3311
  • Fax: 909-338-3217
Mailing address:
  • Phone: 909-338-3311
  • Fax: 909-338-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. TARA ASTRAN
Title or Position: FINANCE OFFICER
Credential:
Phone: 909-338-3311