Provider Demographics
NPI:1083490528
Name:SQUARE, JOHN EARL I
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EARL
Last Name:SQUARE
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6545 SEINE CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-2606
Mailing Address - Country:US
Mailing Address - Phone:909-312-8361
Mailing Address - Fax:
Practice Address - Street 1:6545 SEINE CT
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-2606
Practice Address - Country:US
Practice Address - Phone:909-312-8361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)