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General NPI Number Information
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NPI Number | 1376774935
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Entity Type | Organization
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Legal Business Name | ATLANTIC EXPRESS CO INC
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Dates
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Enumeration Date | 07/30/2009
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Last Update Date | 10/14/2009
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Provider Practice Location Address
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Address Line | 4252 BONITA RD SUITE 82
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City | BONITA
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State | CA
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Zip | 91902-1420
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Country | US
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Telephone | 619-829-1271
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Fax |
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Provider Business Mailing Address
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Address Line | 4252 BONITA RD SUITE 82
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City | BONITA
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State | CA
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Zip | 91902-1420
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BRIAN J CARRIE
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Credential |
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Telephone | 619-829-1271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | A33408
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License Number State | CA
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