Healthcare Provider Details

I. General information

NPI: 1528112331
Provider Name (Legal Business Name): PENINSULA FIRE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/21/2022
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 GOLF CLUB RD
LAKE ALMANOR CA
96137
US

IV. Provider business mailing address

801 GOLF CLUB RD
LAKE ALMANOR CA
96137-9524
US

V. Phone/Fax

Practice location:
  • Phone: 530-259-2306
  • Fax: 530-259-3707
Mailing address:
  • Phone: 530-259-2306
  • Fax: 530-259-3707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416S0300X
TaxonomyWater Ambulance
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. HOLLY C COONS
Title or Position: ADMINISTRATIVE SECRETARY
Credential:
Phone: 530-259-2306