Healthcare Provider Details

I. General information

NPI: 1760058960
Provider Name (Legal Business Name): HEART AMBULANCE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11629 CLARK ST STE 201
ARCADIA CA
91006-6030
US

IV. Provider business mailing address

11629 CLARK ST STE 201
ARCADIA CA
91006-6030
US

V. Phone/Fax

Practice location:
  • Phone: 323-376-3088
  • Fax:
Mailing address:
  • Phone: 323-376-3088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JACOB J SILVA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 323-376-3088