Provider Demographics
NPI:1699003228
Name:AMBULINE AMBULANCE INC.
Entity Type:Organization
Organization Name:AMBULINE AMBULANCE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PROSHAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-974-1155
Mailing Address - Street 1:12104 HOFFMAN ST APT 301
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-4752
Mailing Address - Country:US
Mailing Address - Phone:323-974-1155
Mailing Address - Fax:
Practice Address - Street 1:10537 MAGNOLIA BLVD STE B
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-4114
Practice Address - Country:US
Practice Address - Phone:323-974-1155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport