# MISSION AMBULANCE INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205866423
- **Authorized official:** DANIEL GILLES GOLD (PRESIDENT)
- **Authorized official phone:** (951) 808-8758

## Contact information

- **Practice address:** 1055 E 3RD ST, CORONA, CA 92879-1606
- **Practice address phone:** (951) 808-8758
- **Practice address fax:** (951) 808-8730
- **Mailing address:** PO BOX 3111, CORONA, CA 92878-3111
- **Mailing address phone:** (951) 808-8758
- **Mailing address fax:** (951) 808-8730

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 341600000X | Ambulance | C2221622 | CA | Yes |

## Other

- **Enumeration date:** 07/04/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | MTE01116F | — | CA |
| 01 | — | ZZZ04700Z | BLUE SHIELD | CA |