Healthcare Provider Details

I. General information

NPI: 1447500558
Provider Name (Legal Business Name): RELIABLE MEDICAL TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7317 EL CAJON BLVD
LA MESA CA
91942-7434
US

IV. Provider business mailing address

3717 EL CAJON BLVD
LA MESA CA
91942
US

V. Phone/Fax

Practice location:
  • Phone: 619-698-1455
  • Fax: 619-460-1743
Mailing address:
  • Phone: 619-698-1455
  • Fax: 619-460-1743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License NumberN5490093
License Number StateCA

VIII. Authorized Official

Name: MRS. AGNES A GONGORA
Title or Position: OWNER
Credential:
Phone: 619-698-1455