1487659413 NPI number — CITY OF AVALON DIRECTOR OF FINANCE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487659413 NPI number — CITY OF AVALON DIRECTOR OF FINANCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF AVALON DIRECTOR OF FINANCE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CITY OF AVALON FIRE DEPARTMENT, AVALON FIRE DEPARTMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487659413
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 AVALON CANYON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVALON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-510-0203
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KRUG
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
310-510-0203

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZZ434882 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590014306 . This is a "RRB" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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