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General NPI Number Information
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NPI Number | 1598058620
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Entity Type | Organization
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Legal Business Name | MY RIDE TRANSPORT
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Dates
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Enumeration Date | 05/23/2011
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Last Update Date | 05/23/2011
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Provider Practice Location Address
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Address Line | 527 TERMINO AVE
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City | CORONA
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State | CA
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Zip | 92879-1131
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Country | US
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Telephone | 951-531-8954
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Fax |
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Provider Business Mailing Address
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Address Line | 527 TERMINO AVE
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City | CORONA
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State | CA
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Zip | 92879-1131
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Country | US
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Telephone | 951-531-8954
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Fax |
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Authorized Official
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Title or Position | REGISTERED NURSE
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Name | GAVIOLA PULMONES
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Credential | RN, BSN
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Telephone | 951-531-8954
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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 | 1357K D/P
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License Number State | CA
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