Organization
SHAMROCK LODGE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CORAZON LIBRE DAGUPLO (PRESIDENT)
(909) 238-9771
Entity
Organization
Contact information
Practice address
17611 SHAMROCK AVE, FONTANA, CA 92336-2233
(909) 349-1145
Mailing address
17611 SHAMROCK AVE, FONTANA, CA 92336-2233
(909) 349-1145
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
C4747645
CA
Other
Enumeration date
01/09/2008
Last updated
03/31/2008
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