Provider Demographics
NPI:1033373394
Name:LIBERTY AMBULANCE LLC
Entity Type:Organization
Organization Name:LIBERTY AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ-CONTI
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPA
Authorized Official - Phone:858-653-4520
Mailing Address - Street 1:9770 CANDIDA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4536
Mailing Address - Country:US
Mailing Address - Phone:858-653-4520
Mailing Address - Fax:858-653-4537
Practice Address - Street 1:9441 WASHBURN RD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2912
Practice Address - Country:US
Practice Address - Phone:858-653-4520
Practice Address - Fax:858-653-4537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3416L0300X3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport