Healthcare Provider Details

I. General information

NPI: 1669472023
Provider Name (Legal Business Name): SAN ANDREAS AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 ST CHARLES ST
SAN ANDREAS CA
95249
US

IV. Provider business mailing address

PO BOX 1115
SAN ANDREAS CA
95249-1115
US

V. Phone/Fax

Practice location:
  • Phone: 209-754-5701
  • Fax:
Mailing address:
  • Phone:
  • 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: DALE JONES
Title or Position: OWNER
Credential:
Phone: 209-754-5701