=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497845846
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROGELIO MALANA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2006
-----------------------------------------------------
Last Update Date | 09/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31141 OLD TRAIL CIR
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92563-6272
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-482-2255
-----------------------------------------------------
Fax | 619-482-2256
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31141 OLD TRAIL CIR
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92563-6272
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-482-2255
-----------------------------------------------------
Fax | 619-482-2256
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 44789386
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------