Provider Demographics
NPI:1205866423
Name:MISSION AMBULANCE INC
Entity Type:Organization
Organization Name:MISSION AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:GILLES
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-808-8758
Mailing Address - Street 1:PO BOX 3111
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-3111
Mailing Address - Country:US
Mailing Address - Phone:951-808-8758
Mailing Address - Fax:951-808-8730
Practice Address - Street 1:1055 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-1606
Practice Address - Country:US
Practice Address - Phone:951-808-8758
Practice Address - Fax:951-808-8730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC2221622341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE01116FMedicaid
CAZZZ04700ZOtherBLUE SHIELD
CAZZZ04700ZOtherBLUE SHIELD
CAZZZ18438ZMedicare ID - Type Unspecified