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General NPI Number Information
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NPI Number | 1003838046
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Entity Type | Organization
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Legal Business Name | MEDFLEET AMBULANCE SERVICE INC
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 9960 CAMPO RD 105
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City | SPRING VALLEY
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State | CA
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Zip | 91977-1605
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Country | US
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Telephone | 619-222-2244
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Fax | 619-222-2843
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Provider Business Mailing Address
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Address Line | 9960 CAMPO RD 105
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City | SPRING VALLEY
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State | CA
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Zip | 91977-1605
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Country | US
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Telephone | 619-222-2244
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Fax | 619-222-2843
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | GREGORY LYDELL GIBSON
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Credential |
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Telephone | 619-222-2244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 1867
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License Number State | CA
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