Healthcare Provider Details

I. General information

NPI: 1134764806
Provider Name (Legal Business Name): TONY'S LIMOUSINE SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2019
Last Update Date: 11/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11648 MAYFIELD AVE APT 301
LOS ANGELES CA
90049-5777
US

IV. Provider business mailing address

11648 MAYFIELD AVE APT 301
LOS ANGELES CA
90049-5777
US

V. Phone/Fax

Practice location:
  • Phone: 424-209-8948
  • Fax:
Mailing address:
  • Phone: 424-209-8948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTONY MALDONADO
Title or Position: MANAGER
Credential:
Phone: 424-209-8948