Healthcare Provider Details

I. General information

NPI: 1689228058
Provider Name (Legal Business Name): TRINITY AMBULANCE SAN DIEGO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2563 MAST WAY STE 203
CHULA VISTA CA
91914-4539
US

IV. Provider business mailing address

2563 MAST WAY STE 203
CHULA VISTA CA
91914-4539
US

V. Phone/Fax

Practice location:
  • Phone: 619-587-0015
  • Fax: 619-216-4428
Mailing address:
  • Phone: 619-587-0015
  • Fax: 619-216-4428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: LUIS LOPEZ
Title or Position: PRESIDENT
Credential:
Phone: 619-587-0015