MEDICARE: SYCUAN TRIBAL GOVERNMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	1570	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043218191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYCUAN TRIBAL GOVERNMENT

Provider Business Mailing Address
First Line	:	2 KWAAYPAAY CT
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92019-1832
Country	:	US
Telephone Number	:	619-445-4564
Fax Number	:	619-445-9764

Provider Business Practice Location Address
First Line	:	5449 SYCUAN RD
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92019-1821
Country	:	US
Telephone Number	:	619-445-4564
Fax Number	:	619-445-9764

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. TROY GRAVES
Credential	:
Telephone Number	:	619-445-4564

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	05/12/2014

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Directions to “SYCUAN TRIBAL GOVERNMENT ” Practice Location

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