Healthcare Provider Details

I. General information

NPI: 1497024731
Provider Name (Legal Business Name): COUNTY SERVICE AREA NO 17
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5560 OVERLAND AVE STE 400
SAN DIEGO CA
92123-1204
US

IV. Provider business mailing address

5560 OVERLAND AVENUE, SUITE 400
SAN DIEGO CA
92123-1204
US

V. Phone/Fax

Practice location:
  • Phone: 858-245-4231
  • Fax:
Mailing address:
  • Phone: 858-245-4231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: ANDREW DORMANN PARR
Title or Position: EMS ADMINISTRATOR
Credential:
Phone: 858-245-4231