Organization
LIFEWEST SOUTHERN CALIFORNIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY TENNYSON (SHAREHOLDER)
(775) 722-0123
Entity
Organization
Contact information
Practice address
4223 PONDEROSA AVE STE A, SAN DIEGO, CA 92123-1529
(480) 874-6700
Mailing address
5225 N SCOTTSDALE RD STE 102, SCOTTSDALE, AZ 85250-7011
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
—
—
3416L0300X
Land Ambulance
Primary
—
—
Other
Enumeration date
01/08/2019
Last updated
01/09/2019
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