Provider Demographics
NPI:1982760948
Name:TOWN OF CORTE MADERA
Entity Type:Organization
Organization Name:TOWN OF CORTE MADERA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-927-5077
Mailing Address - Street 1:P.O. BOX 80146
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91716
Mailing Address - Country:US
Mailing Address - Phone:415-878-2642
Mailing Address - Fax:
Practice Address - Street 1:342 TAMALPAIS DR
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1492
Practice Address - Country:US
Practice Address - Phone:415-927-5077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE00978FMedicaid
ZZZ14983ZMedicare PIN