Healthcare Provider Details

I. General information

NPI: 1225578636
Provider Name (Legal Business Name): TEMECULA PARA TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2017
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31220 LOCUST CT
TEMECULA CA
92592-6863
US

IV. Provider business mailing address

31220 LOCUST CT
TEMECULA CA
92592-6863
US

V. Phone/Fax

Practice location:
  • Phone: 951-795-3571
  • Fax: 951-383-8419
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number01981
License Number StateCA

VIII. Authorized Official

Name: MANUEL AUSTRIA
Title or Position: OWNER
Credential:
Phone: 951-795-3571