Provider Demographics
NPI:1629036652
Name:SHORELINE AMBULANCE INC
Entity Type:Organization
Organization Name:SHORELINE AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GIOVANNI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-847-9107
Mailing Address - Street 1:17762 METZLER LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6245
Mailing Address - Country:US
Mailing Address - Phone:714-847-9107
Mailing Address - Fax:714-848-6943
Practice Address - Street 1:17762 METZLER LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6245
Practice Address - Country:US
Practice Address - Phone:714-847-9107
Practice Address - Fax:714-848-6943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE01225GMedicaid
CAZ552Medicare PIN