MEDICARE: CITY OF CORONADO

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

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	:	1487650602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF CORONADO

Provider Business Mailing Address
First Line	:	PO BOX 269110
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95826-9110
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 6TH ST
Second Line	:
City	:	CORONADO
State	:	CA
Zip	:	92118-1711
Country	:	US
Telephone Number	:	619-522-7374
Fax Number	:

Authorized Official
Title or Position	:	FIRE CHIRF
Name	:	DAN MATSTRO
Credential	:
Telephone Number	:	619-522-7374

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	10/17/2007

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Directions to “CITY OF CORONADO ” Practice Location

Language	Start Address	Practice Location

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