Provider Demographics
NPI:1962556738
Name:DEEPAMERICA INC
Entity type:Organization
Organization Name:DEEPAMERICA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESITA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLARUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-863-5089
Mailing Address - Street 1:123 W BADILLO ST STE C
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-2026
Mailing Address - Country:US
Mailing Address - Phone:626-339-7035
Mailing Address - Fax:
Practice Address - Street 1:123 W BADILLO ST STE C
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-2026
Practice Address - Country:US
Practice Address - Phone:626-339-7035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTN00669F343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN00669FMedicaid