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General NPI Number Information
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NPI Number | 1568713493
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Entity Type | Organization
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Legal Business Name | IRIDE TRANSPORT SERVICES, LLC
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Dates
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Enumeration Date | 10/02/2012
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 3296 MONTE VERDE LN
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City | SAN JOSE
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State | CA
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Zip | 95135-2318
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Country | US
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Telephone | 408-223-1619
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Fax | 408-270-4816
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Provider Business Mailing Address
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Address Line | 3296 MONTE VERDE LN
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City | SAN JOSE
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State | CA
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Zip | 95135-2318
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Country | US
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Telephone | 408-223-1619
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Fax | 408-270-4816
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Authorized Official
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Title or Position | OWNER/CEO
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Name | EDUARDO B. ALBANO SR.
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Credential |
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Telephone | 408-223-1619
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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 | 201203010136
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License Number State | CA
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