=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801479076
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RINCON BAND OF LUISENO MISSION INDIANS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2021
-----------------------------------------------------
Last Update Date | 11/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33485 VALLEY CENTER RD
-----------------------------------------------------
City | VALLEY CENTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92082-6047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-297-2300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 GOVERNMENT CENTER LN
-----------------------------------------------------
City | VALLEY CENTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92082-5344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-297-2300
-----------------------------------------------------
Fax | 760-297-2320
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FIRE CHIEF
-----------------------------------------------------
Name | CHIP DUNCAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 760-297-2320
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------