MEDICARE: CITY OF HERMOSA BEACH

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	590011942	OTHER	CA	RRB
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972588192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF HERMOSA BEACH

Provider Business Mailing Address
First Line	:	PO BOX 269110
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95826-9110
Country	:	US
Telephone Number	:	800-906-6552
Fax Number	:

Provider Business Practice Location Address
First Line	:	1315 VALLEY DR
Second Line	:	STE 201
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254
Country	:	US
Telephone Number	:	310-376-2479
Fax Number	:

Authorized Official
Title or Position	:	FINANCE DIRECTOR
Name	:	VIKI LEA COPELAND
Credential	:
Telephone Number	:	310-318-0225

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	12/17/2019

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Directions to “CITY OF HERMOSA BEACH ” Practice Location

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