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General NPI Number Information
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NPI Number | 1700136405
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Entity Type | Organization
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Legal Business Name | MID-CITIES MEDICAL TRANSPORT
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Dates
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Enumeration Date | 09/11/2012
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 1325 N RED GUM ST # 14
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City | ANAHEIM
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State | CA
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Zip | 92806-1326
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Country | US
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Telephone | 714-238-9005
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Fax | 714-238-9085
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Provider Business Mailing Address
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Address Line | 1325 N. RED GUM ST. # 14
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City | ANAHEIM
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State | CA
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Zip | 92806-1387
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Country | US
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Telephone | 714-238-9005
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Fax | 714-238-9085
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Authorized Official
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Title or Position | OPERATION MANAGER
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Name | MR. CONRADO VILLASENOR MANIMBO
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Credential |
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Telephone | 714-238-9005
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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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