Healthcare Provider Details

I. General information

NPI: 1811043805
Provider Name (Legal Business Name): VICTORY ROYAL EXPRESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 HOT SPRINGS BLVD
LAS VEGAS NM
87701-4119
US

IV. Provider business mailing address

PO BOX 670
LAS VEGAS NM
87701-0670
US

V. Phone/Fax

Practice location:
  • Phone: 505-425-5170
  • Fax: 505-425-5175
Mailing address:
  • Phone: 505-425-5170
  • Fax: 505-425-5175

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: PHEBE GUTIERREZ
Title or Position: TRANSPORTATION DIRECTOR
Credential:
Phone: 505-425-5170