Provider Demographics
NPI:1487659413
Name:CITY OF AVALON DIRECTOR OF FINANCE
Entity Type:Organization
Organization Name:CITY OF AVALON DIRECTOR OF FINANCE
Other - Org Name:CITY OF AVALON FIRE DEPARTMENT, AVALON FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-510-0203
Mailing Address - Street 1:PO BOX 269110
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-9110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 AVALON CANYON DR
Practice Address - Street 2:
Practice Address - City:AVALON
Practice Address - State:CA
Practice Address - Zip Code:90704
Practice Address - Country:US
Practice Address - Phone:310-510-0203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ434882Medicaid
CA590014306OtherRRB
CAZA152Medicare PIN
CAZ152Medicare PIN