Healthcare Provider Details

I. General information

NPI: 1407105638
Provider Name (Legal Business Name): VEKIEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10757 LEMON AVE APT 1224
RANCHO CUCAMONGA CA
91737-6948
US

IV. Provider business mailing address

PO BOX 991
RANCHO CUCAMONGA CA
91729-0991
US

V. Phone/Fax

Practice location:
  • Phone: 909-972-6545
  • Fax:
Mailing address:
  • Phone: 909-972-6545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number201210810014
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3418M1110X
TaxonomyMilitary or U.S. Coast Guard Ground Transport Ambulance
License Number201210810014
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number201210810014
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number201210810014
License Number StateCA

VIII. Authorized Official

Name: ANDREW ADDY
Title or Position: PRESIDENT
Credential:
Phone: 909-972-6545