=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669602751
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILITARY TECH TEMPS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2009
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5761 WHITNALL HWY STE D
-----------------------------------------------------
City | N HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91601-2101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-628-8003
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 N VICTORY BLVD # L270
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91502-1847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-628-8003
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. OSCAR M BORRERO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-628-8003
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------