Organization
SOUTH LAKE TAHOE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SALLIE ROSS (ADMINISTRATIVE ASSISTANT)
(530) 542-6152
Entity
Organization
Contact information
Practice address
2101 LAKE TAHOE BLVD, SOUTH LAKE TAHOE, CA 96150-6424
(530) 542-6164
Mailing address
PO BOX 510, ALAMEDA, CA 94501-9610
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
—
—
Other
Enumeration date
01/02/2007
Last updated
06/30/2008
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