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General NPI Number Information
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NPI Number | 1033373394
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Entity Type | Organization
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Legal Business Name | LIBERTY AMBULANCE LLC
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Dates
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Enumeration Date | 07/16/2008
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Last Update Date | 08/18/2011
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Provider Practice Location Address
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Address Line | 9441 WASHBURN RD
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City | DOWNEY
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State | CA
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Zip | 90242-2912
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Country | US
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Telephone | 858-653-4520
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Fax | 858-653-4537
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Provider Business Mailing Address
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Address Line | 9770 CANDIDA ST
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City | SAN DIEGO
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State | CA
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Zip | 92126-4536
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Country | US
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Telephone | 858-653-4520
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Fax | 858-653-4537
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. MANNY DIAZ-CONTI JR.
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Credential | CPA
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Telephone | 858-653-4520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 3416L0300X
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License Number State | CA
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