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General NPI Number Information
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NPI Number | 1265432801
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Entity Type | Organization
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Legal Business Name | SOUTH LAKE COUNTY FIRE PROTECTION DISTRICT
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Dates
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Enumeration Date | 07/26/2005
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Last Update Date | 12/17/2019
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Provider Practice Location Address
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Address Line | 21095 HIGHWAY 175
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City | MIDDLETOWN
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State | CA
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Zip | 95461-9527
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Country | US
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Telephone | 707-987-3089
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 269110
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City | SACRAMENTO
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State | CA
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Zip | 95826-9110
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FIRE CHIEF
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Name | GREG BERTELLI
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Credential |
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Telephone | 707-279-2125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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