Provider Demographics
NPI:1598841934
Name:CAL MED AMBULANCE LLC
Entity Type:Organization
Organization Name:CAL MED AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:ZABALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-721-7679
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-0187
Mailing Address - Country:US
Mailing Address - Phone:909-721-7679
Mailing Address - Fax:909-581-6488
Practice Address - Street 1:1717 TIFFANY CT
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-5646
Practice Address - Country:US
Practice Address - Phone:909-721-7679
Practice Address - Fax:909-581-6488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZ541341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZ541Medicare ID - Type Unspecified