Provider Demographics
NPI:1679690614
Name:YUCCA VALLEY FIRE DISTRICT
Entity type:Organization
Organization Name:YUCCA VALLEY FIRE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-387-6158
Mailing Address - Street 1:157 W 5TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-1012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:57485 AVIATION DR
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3009
Practice Address - Country:US
Practice Address - Phone:760-365-3335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00012174OtherRRB
CAZZZ70804ZMedicaid
CAZZZ93899ZMedicare PIN