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General NPI Number Information
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NPI Number | 1134452584
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Entity Type | Organization
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Legal Business Name | EJECUTIVOS TAXI
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 09/16/2009
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Provider Practice Location Address
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Address Line | 13014 N 31ST AVE HOUSE
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City | PHOENIX
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State | AZ
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Zip | 85029-1332
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Country | US
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Telephone | 602-678-1444
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Fax | 602-371-0666
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Provider Business Mailing Address
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Address Line | 13014 N 31ST AVE
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City | PHOENIX
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State | AZ
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Zip | 85029
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Country | US
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Telephone | 602-678-1444
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Fax | 602-371-0666
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Authorized Official
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Title or Position | OWNER
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Name | JOSE PRADO SERPA
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Credential |
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Telephone | 602-678-1444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number | 25666
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License Number State | AZ
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