Healthcare Provider Details

I. General information

NPI: 1063858611
Provider Name (Legal Business Name): CITY OF ONTARIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E B ST
ONTARIO CA
91764-4107
US

IV. Provider business mailing address

425 E B ST
ONTARIO CA
91764-4107
US

V. Phone/Fax

Practice location:
  • Phone: 909-395-2002
  • Fax: 909-395-2556
Mailing address:
  • Phone: 909-395-2002
  • Fax: 909-395-2556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYMOND GAYK
Title or Position: FIRE CHIEF
Credential:
Phone: 909-395-2002