Provider Demographics
NPI:1871502146
Name:BALBOA AMBULANCE INC.
Entity Type:Organization
Organization Name:BALBOA AMBULANCE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-440-9386
Mailing Address - Street 1:PO BOX 34577
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-4577
Mailing Address - Country:US
Mailing Address - Phone:858-637-3521
Mailing Address - Fax:858-284-9848
Practice Address - Street 1:3550 AFTON RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2184
Practice Address - Country:US
Practice Address - Phone:858-637-3524
Practice Address - Fax:858-284-9848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1153473416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE00734FMedicaid
CA05-102OtherSAN DIEGO EMS PERMIT
115347OtherCHP LICENSE
CA05-102OtherSAN DIEGO EMS PERMIT