Healthcare Provider Details

I. General information

NPI: 1942610126
Provider Name (Legal Business Name): LIFE SUPPORT AMBULANCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 10/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 AGATE CREEK WAY
CHULA VISTA CA
91915-1636
US

IV. Provider business mailing address

2831 SAINT ROSE PKWY
HENDERSON NV
89052-4840
US

V. Phone/Fax

Practice location:
  • Phone: 619-988-6512
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MR. JESUS CARSON
Title or Position: MANAGER
Credential:
Phone: 619-988-6512