Provider Demographics
NPI:1699832584
Name:CITY OF SAN RAFAEL
Entity Type:Organization
Organization Name:CITY OF SAN RAFAEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-485-3084
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-4330
Mailing Address - Country:US
Mailing Address - Phone:415-485-3304
Mailing Address - Fax:415-453-1627
Practice Address - Street 1:1375 5TH AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-1942
Practice Address - Country:US
Practice Address - Phone:415-485-3084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE00308FMedicaid
CA590008681Medicare PIN
CAMTE00308FMedicaid