1740280494 NPI number — CITY OF LA VERNE

Table of content: (NPI 1740280494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740280494 NPI number — CITY OF LA VERNE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF LA VERNE
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:
Provider Other Organization Name Type Code:
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:
1740280494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2019
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:
2061 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA VERNE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91750-4404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-596-5991
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JANKOWSKI
Authorized Official First Name:
PETE
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
909-596-5991

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: MTE01111F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00062153 . This is a "RRB" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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