Provider Demographics
NPI:1841380763
Name:DEL PUERTO HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:DEL PUERTO HEALTH CARE DISTRICT
Other - Org Name:PATTERSON DISTRICT AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF AMBULANCE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-892-2618
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-0187
Mailing Address - Country:US
Mailing Address - Phone:209-892-2618
Mailing Address - Fax:209-892-3755
Practice Address - Street 1:875 E ST
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-2670
Practice Address - Country:US
Practice Address - Phone:209-892-2618
Practice Address - Fax:209-892-3755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE00216FMedicaid
59002282OtherMEDICARE UNION PACIFIC
59002282OtherMEDICARE UNION PACIFIC