Healthcare Provider Details

I. General information

NPI: 1245527290
Provider Name (Legal Business Name): RELIABLE MEDICAL TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 02/12/2013
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

7317 EL CAJON BLVD
LA MESA CA
91942-7434
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 Code343900000X
TaxonomyNon-emergency 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