Healthcare Provider Details

I. General information

NPI: 1578677696
Provider Name (Legal Business Name): CITY OF SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S DR EE DUNLAP HIGHWAY
SAN DIEGO TX
78384-4320
US

IV. Provider business mailing address

404 S. MIER ST.
SAN DIEGO TX
78384-4320
US

V. Phone/Fax

Practice location:
  • Phone: 361-279-3341
  • Fax: 361-279-3401
Mailing address:
  • Phone: 631-279-3341
  • Fax: 361-279-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number066007
License Number StateTX

VIII. Authorized Official

Name: ISSABELLE N. GARCIA
Title or Position: CITY MANAGER
Credential:
Phone: 361-279-3341