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General NPI Number Information
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NPI Number | 1962556738
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Entity Type | Organization
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Legal Business Name | DEEPAMERICA INC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 01/25/2011
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Provider Practice Location Address
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Address Line | 123 W BADILLO ST STE C
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City | COVINA
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State | CA
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Zip | 91723-2026
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Country | US
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Telephone | 626-339-7035
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Fax |
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Provider Business Mailing Address
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Address Line | 123 W BADILLO ST STE C
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City | COVINA
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State | CA
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Zip | 91723-2026
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Country | US
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Telephone | 626-339-7035
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. TERESITA VILLARUZ
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Credential |
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Telephone | 714-863-5089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | MTN00669F
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License Number State | CA
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