Healthcare Provider Details

I. General information

NPI: 1952138521
Provider Name (Legal Business Name): ST. MARK AMBULANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 EL CAMINO REAL STE 424
MILLBRAE CA
94030-2643
US

IV. Provider business mailing address

475 EL CAMINO REAL STE 424
MILLBRAE CA
94030-2643
US

V. Phone/Fax

Practice location:
  • Phone: 650-880-2588
  • Fax: 650-880-2577
Mailing address:
  • Phone: 650-880-2588
  • Fax: 650-880-2577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARK VICTOR IGNACIO
Title or Position: OWNER/CEO
Credential: RN, EMT
Phone: 650-483-2169