Healthcare Provider Details

I. General information

NPI: 1770206450
Provider Name (Legal Business Name): SANTEE-LAKESIDE EMERGENCY MEDICAL SERVICES AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 COTTONWOOD AVE
SANTEE CA
92071-3092
US

IV. Provider business mailing address

10601 N MAGNOLIA AVE
SANTEE CA
92071-1222
US

V. Phone/Fax

Practice location:
  • Phone: 619-258-4100
  • Fax:
Mailing address:
  • Phone: 619-258-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JUSTIN MATSUSHITA
Title or Position: DEPUTY FIRE CHIEF
Credential:
Phone: 619-258-4100