Healthcare Provider Details

I. General information

NPI: 1144563784
Provider Name (Legal Business Name): MEMORIAL MEDICAL TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 PACIFIC AVE
LONG BEACH CA
90813-1714
US

IV. Provider business mailing address

1725 PACIFIC AVE
LONG BEACH CA
90813-1714
US

V. Phone/Fax

Practice location:
  • Phone: 562-599-0688
  • Fax:
Mailing address:
  • Phone: 562-599-0688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: LEE DANIELS YOSELOFF
Title or Position: PRESIDENT
Credential: M.D., J.D
Phone: 562-599-0688