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General NPI Number Information
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NPI Number | 1861574584
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Entity Type | Organization
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Legal Business Name | MANTECA DISTRICT VOLUNTEER AMBULANCE SERVICE
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 01/05/2012
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Provider Practice Location Address
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Address Line | 245 E CENTER ST
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City | MANTECA
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State | CA
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Zip | 95336-4623
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Country | US
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Telephone | 209-823-1032
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Fax | 209-825-9607
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Provider Business Mailing Address
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Address Line | PO BOX 2
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City | MANTECA
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State | CA
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Zip | 95336-1120
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Country | US
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Telephone | 209-823-1032
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Fax | 209-825-9607
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. MELISSA LOU ANN ANAYA
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Credential |
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Telephone | 209-823-1032
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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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