MEDICARE: PROCARE MOBILE RESPONSE, LLC

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	3416L0300X	Land Ambulance	1885	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467497172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROCARE MOBILE RESPONSE, LLC

Provider Business Mailing Address
First Line	:	2702 MEDIA CENTER DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90065-1733
Country	:	US
Telephone Number	:	800-676-0311
Fax Number	:	800-676-4133

Provider Business Practice Location Address
First Line	:	2702 MEDIA CENTER DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90065-1733
Country	:	US
Telephone Number	:	800-676-0311
Fax Number	:	800-676-4133

Authorized Official
Title or Position	:	CEO
Name	:	MR. ZINOVY GANOPOLSKY
Credential	:
Telephone Number	:	800-676-0311

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	10/03/2008

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Directions to “PROCARE MOBILE RESPONSE, LLC ” Practice Location

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