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General NPI Number Information
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NPI Number | 1396194627
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL AIR AMBULANCE
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Dates
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Enumeration Date | 06/07/2016
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Last Update Date | 06/07/2016
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Provider Practice Location Address
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Address Line | 18818 N 62ND DR
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City | GLENDALE
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State | AZ
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Zip | 85308-7647
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Country | US
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Telephone | 623-261-1716
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Fax |
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Provider Business Mailing Address
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Address Line | 18818 N 62ND DR
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City | GLENDALE
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State | AZ
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Zip | 85308-7647
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Country | US
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Telephone | 623-261-1716
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MANNY ENRIQUE SALGADO
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Credential |
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Telephone | 623-261-1716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416A0800X
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Taxonomy Name | Air Ambulance
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License Number |
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License Number State |
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