Provider Demographics
NPI:1497024731
Name:COUNTY SERVICE AREA NO 17
Entity Type:Organization
Organization Name:COUNTY SERVICE AREA NO 17
Other - Org Name:CSA 17 SAN DIEGUITO AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:DORMANN
Authorized Official - Last Name:PARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-245-4231
Mailing Address - Street 1:5560 OVERLAND AVENUE, SUITE 400
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1204
Mailing Address - Country:US
Mailing Address - Phone:858-245-4231
Mailing Address - Fax:
Practice Address - Street 1:5560 OVERLAND AVE STE 400
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1204
Practice Address - Country:US
Practice Address - Phone:858-245-4231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGA804AMedicare PIN