=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184919318
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALESNA EMS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2011
-----------------------------------------------------
Last Update Date | 06/16/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 480 CHATSWORTH DR UNIT 2
-----------------------------------------------------
City | SAN FERNANDO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91340-3764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-403-9923
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 480 CHATSWORTH DR UNIT 2
-----------------------------------------------------
City | SAN FERNANDO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91340-3764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-403-9923
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JORGE ALESNA SR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-403-9923
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------