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General NPI Number Information
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NPI Number | 1396299467
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Entity Type | Organization
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Legal Business Name | GOLDEN HEART TRANS LLC
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Dates
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Enumeration Date | 08/06/2016
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Last Update Date | 08/06/2016
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Provider Practice Location Address
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Address Line | 11939 W COLUMBINE DR
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City | EL MIRAGE
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State | AZ
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Zip | 85335-3369
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Country | US
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Telephone | 623-476-2243
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Fax | 623-476-5646
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Provider Business Mailing Address
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Address Line | 11939 W COLUMBINE DR
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City | EL MIRAGE
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State | AZ
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Zip | 85335-3369
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Country | US
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Telephone | 623-476-2243
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Fax | 623-476-5646
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Authorized Official
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Title or Position | OWNER/PRESIDDENT
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Name | CARLOS JAVIER VILLICANA TAPIA
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Credential |
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Telephone | 623-606-1907
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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 | D02901838
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License Number State | AZ
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