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General NPI Number Information
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NPI Number | 1235850181
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Entity Type | Organization
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Legal Business Name | DIAMONDS MEDICAL TRANSPORTATION LLC
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Dates
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Enumeration Date | 09/08/2022
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 11417 W EDGEMONT AVE
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City | AVONDALE
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State | AZ
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Zip | 85392-5657
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Country | US
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Telephone | 602-910-9659
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Fax |
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Provider Business Mailing Address
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Address Line | 591 E PLAZA CIR UNIT 2133
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-7685
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Country | US
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Telephone | 602-910-9659
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KENTRELL C MORELAND
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Credential |
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Telephone | 602-910-9659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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