Healthcare Provider Details

I. General information

NPI: 1447377858
Provider Name (Legal Business Name): IDYLLWILD FIRE PROTECTION DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 12/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54160 MARANATHA DRIVE
IDYLLWILD CA
92549-0656
US

IV. Provider business mailing address

PO BOX 656 54160 MARANATHA DRIVE
IDYLLWILD CA
92549-0656
US

V. Phone/Fax

Practice location:
  • Phone: 951-659-2153
  • Fax: 951-659-5571
Mailing address:
  • Phone: 951-659-2153
  • Fax: 951-659-5571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PATRICK REITZ
Title or Position: FIRE CHIEF
Credential:
Phone: 951-659-2153