Provider Demographics
NPI:1609912419
Name:PROFESSIONAL HEALTHCARE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL HEALTHCARE ASSOCIATES, INC.
Other - Org Name:CAVALRY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-278-3700
Mailing Address - Street 1:420 N MCKINLEY ST STE 111-477
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-8099
Mailing Address - Country:US
Mailing Address - Phone:951-278-3700
Mailing Address - Fax:951-736-1933
Practice Address - Street 1:423 JENKS CIR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92878-5039
Practice Address - Country:US
Practice Address - Phone:951-278-3700
Practice Address - Fax:951-736-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ13518ZOtherBLUE SHIELD PROVIDER NUMBER
CAZZZ25940ZMedicare PIN