Healthcare Provider Details

I. General information

NPI: 1063790111
Provider Name (Legal Business Name): XTRA CARE MEDICAL TRANSPORT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2011
Last Update Date: 07/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6888 LANDRIANO PL
RANCHO CUCAMONGA CA
91701-8521
US

IV. Provider business mailing address

6888 LANDRIANO PL
RANCHO CUCAMONGA CA
91701-8521
US

V. Phone/Fax

Practice location:
  • Phone: 909-972-0311
  • Fax: 909-972-0304
Mailing address:
  • Phone: 909-972-0311
  • Fax: 909-972-0304

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: CLARISSA C REDSAR
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 909-972-0311