Provider Demographics
NPI:1508939943
Name:KMA EMERGENCY SERVICES, INC.
Entity Type:Organization
Organization Name:KMA EMERGENCY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-981-0299
Mailing Address - Street 1:3972 BARRANCA PKWY
Mailing Address - Street 2:SUITE J430
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-8656
Mailing Address - Country:US
Mailing Address - Phone:510-614-1420
Mailing Address - Fax:510-614-1429
Practice Address - Street 1:14275 WICKS BLVD
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-5613
Practice Address - Country:US
Practice Address - Phone:510-614-1420
Practice Address - Fax:510-614-1429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1453416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE00791FMedicaid
CAZZZ00560ZMedicare ID - Type Unspecified