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General NPI Number Information
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NPI Number | 1871502146
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Entity Type | Organization
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Legal Business Name | BALBOA AMBULANCE INC.
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 12/18/2012
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Provider Practice Location Address
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Address Line | 3550 AFTON RD
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City | SAN DIEGO
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State | CA
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Zip | 92123-2184
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Country | US
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Telephone | 858-637-3524
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Fax | 858-284-9848
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Provider Business Mailing Address
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Address Line | PO BOX 34577
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City | SAN DIEGO
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State | CA
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Zip | 92163-4577
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Country | US
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Telephone | 858-637-3521
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Fax | 858-284-9848
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JOHN OLSON
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Credential |
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Telephone | 619-440-9386
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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 | 115347
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License Number State | CA
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