Healthcare Provider Details

I. General information

NPI: 1396802377
Provider Name (Legal Business Name): IMPERIAL BEACH FIRE DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 IMPERIAL BEACH BLVD
IMPERIAL BEACH CA
91932-2702
US

IV. Provider business mailing address

PO BOX 249
ALAMEDA CA
94501-9349
US

V. Phone/Fax

Practice location:
  • Phone: 619-423-8223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: PAUL SMITH
Title or Position: DEPUTY CHIEF
Credential:
Phone: 619-423-8223