Healthcare Provider Details

I. General information

NPI: 1477738755
Provider Name (Legal Business Name): MED-LIFE AMBULANCE SERVICES,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5304 SAN FERNANDO RD
GLENDALE CA
91203-2407
US

IV. Provider business mailing address

PO BOX 4525
GLENDALE CA
91222-0525
US

V. Phone/Fax

Practice location:
  • Phone: 818-500-0044
  • Fax: 818-500-9992
Mailing address:
  • Phone: 818-500-0044
  • Fax: 818-500-9992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. SHAKE SEYSYAN
Title or Position: PRESIDENT
Credential:
Phone: 818-500-0044