Healthcare Provider Details

I. General information

NPI: 1760694897
Provider Name (Legal Business Name): ER AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 JOHNSON AVE. SUITE 116
EL CAJON CA
92020-1649
US

IV. Provider business mailing address

1365 JOHNSON AVE. SUITE 116
EL CAJON CA
92020-1649
US

V. Phone/Fax

Practice location:
  • Phone: 619-401-9900
  • Fax: 619-401-9911
Mailing address:
  • Phone: 619-401-9900
  • Fax: 619-401-9911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number1865
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number1865
License Number StateCA

VIII. Authorized Official

Name: MR. RAFAEL SILVA
Title or Position: VICE PRESIDENT
Credential: EMT
Phone: 443-271-9497