Healthcare Provider Details

I. General information

NPI: 1083613921
Provider Name (Legal Business Name): COUNTY OF TUOLUMNE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18440 STRIKER CT
SONORA CA
95370-7555
US

IV. Provider business mailing address

PO BOX 5024 18440 STRIKER COURT
SONORA CA
95370-5024
US

V. Phone/Fax

Practice location:
  • Phone: 209-533-7368
  • Fax: 209-533-5726
Mailing address:
  • Phone: 209-533-7368
  • Fax: 209-533-5726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. GERALDINE ANN RAINS
Title or Position: FISCAL SUPERVISOR
Credential:
Phone: 209-533-7368