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General NPI Number Information
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NPI Number | 1588948525
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Entity Type | Organization
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Legal Business Name | ST. MARY MAGDALENE MEDICAL TRANSPORT
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 11/14/2011
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Provider Practice Location Address
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Address Line | 17111 S HORST AVENUE
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City | CERRITOS
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State | CA
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Zip | 90703
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Country | US
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Telephone | 562-449-7588
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Fax | 562-865-0128
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Provider Business Mailing Address
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Address Line | P.O. BOX 786
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City | ARTESIA
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State | CA
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Zip | 90702-0786
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Country | US
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Telephone | 562-449-7588
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Fax | 562-865-0128
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Authorized Official
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Title or Position | OWNER
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Name | OPHELIA LAURENTE
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Credential |
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Telephone | 562-427-5164
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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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