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General NPI Number Information
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NPI Number | 1497024731
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Entity Type | Organization
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Legal Business Name | COUNTY SERVICE AREA NO 17
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Dates
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Enumeration Date | 12/15/2011
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Last Update Date | 03/22/2023
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Provider Practice Location Address
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Address Line | 5560 OVERLAND AVE STE 400
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City | SAN DIEGO
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State | CA
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Zip | 92123-1204
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Country | US
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Telephone | 858-245-4231
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Fax |
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Provider Business Mailing Address
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Address Line | 5560 OVERLAND AVENUE, SUITE 400
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City | SAN DIEGO
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State | CA
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Zip | 92123-1204
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Country | US
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Telephone | 858-245-4231
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Fax |
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Authorized Official
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Title or Position | EMS ADMINISTRATOR
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Name | ANDREW DORMANN PARR
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Credential |
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Telephone | 858-245-4231
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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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