Healthcare Provider Details

I. General information

NPI: 1003838046
Provider Name (Legal Business Name): MEDFLEET AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9960 CAMPO RD 105
SPRING VALLEY CA
91977-1605
US

IV. Provider business mailing address

9960 CAMPO RD 105
SPRING VALLEY CA
91977-1605
US

V. Phone/Fax

Practice location:
  • Phone: 619-222-2244
  • Fax: 619-222-2843
Mailing address:
  • Phone: 619-222-2244
  • Fax: 619-222-2843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number1867
License Number StateCA

VIII. Authorized Official

Name: GREGORY LYDELL GIBSON
Title or Position: PRESIDENT CEO
Credential:
Phone: 619-222-2244