MEDICARE: CITY OF SAN DIEGO

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	066007	TX

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	:	1578677696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF SAN DIEGO

Provider Business Mailing Address
First Line	:	404 S MIER ST
Second Line	:
City	:	SAN DIEGO
State	:	TX
Zip	:	78384-3108
Country	:	US
Telephone Number	:	361-279-3321
Fax Number	:	361-279-3401

Provider Business Practice Location Address
First Line	:	100 S DR EE DUNLAP HWY
Second Line	:
City	:	SAN DIEGO
State	:	TX
Zip	:	78384-3202
Country	:	US
Telephone Number	:	361-279-3321
Fax Number	:	361-279-3401

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DAVID LOPEZ JR.
Credential	:
Telephone Number	:	361-279-3321

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	02/04/2026

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Directions to “CITY OF SAN DIEGO ” Practice Location

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