MEDICARE: GENTLECARE TRANSPORT, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance
2	341600000X	Ambulance		CA

General Provider Information

NPI Number	:	1366622409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTLECARE TRANSPORT, INC.

Provider Business Mailing Address
First Line	:	3539 CASITAS AVE.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1903
Country	:	US
Telephone Number	:	323-662-8777
Fax Number	:	323-663-8765

Provider Business Practice Location Address
First Line	:	3539 CASITAS AVE.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1903
Country	:	US
Telephone Number	:	323-662-8777
Fax Number	:	323-663-8765

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	MR. ROBERT DOUGLAS SPIRO JR.
Credential	:
Telephone Number	:	323-662-8777

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	06/15/2015

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