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General NPI Number Information
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NPI Number | 1265733216
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Entity Type | Organization
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Legal Business Name | LEXXCARE
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Dates
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Enumeration Date | 11/08/2010
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Last Update Date | 11/08/2010
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Provider Practice Location Address
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Address Line | 445 S STATE ST
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City | SAN JACINTO
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State | CA
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Zip | 92583-4013
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Country | US
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Telephone | 800-560-8547
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Fax |
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Provider Business Mailing Address
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Address Line | 11690 PACIFIC AVE SUITE 301
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City | FONTANA
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State | CA
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Zip | 92337-8254
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Country | US
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Telephone | 909-581-7488
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | MR. JERRY BOUCHER
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Credential |
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Telephone | 909-581-7488
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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 |
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License Number State |
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