Provider Demographics
NPI:1568770188
Name:XTREME CARE AMBULANCE INC
Entity Type:Organization
Organization Name:XTREME CARE AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SOUHEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JAWAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-822-2674
Mailing Address - Street 1:4636 MISSION GORGE PL
Mailing Address - Street 2:SUITE 103-C
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4151
Mailing Address - Country:US
Mailing Address - Phone:619-822-2674
Mailing Address - Fax:619-255-2590
Practice Address - Street 1:4636 MISSION GORGE PL
Practice Address - Street 2:STE 103-C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4151
Practice Address - Country:US
Practice Address - Phone:619-822-2674
Practice Address - Fax:619-255-2590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33118383416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport