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General NPI Number Information
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NPI Number | 1750827192
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Entity Type | Organization
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Legal Business Name | ECUADORIAN EXPRESS LLC
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Dates
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Enumeration Date | 01/09/2017
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 3905 VAN BUREN ST NE
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City | MINNEAPOLIS
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State | MN
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Zip | 55421-3956
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Country | US
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Telephone | 612-788-0607
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Fax |
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Provider Business Mailing Address
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Address Line | 3905 VAN BUREN ST NE
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City | MINNEAPOLIS
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State | MN
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Zip | 55421-3956
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Country | US
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Telephone | 612-788-0607
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Fax |
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Authorized Official
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Title or Position | OWNER/MANNAGER
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Name | MR. CARLOS ARTURO ILLISACA I
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Credential |
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Telephone | 612-788-0607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number | L25650022
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number | L256 50022
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License Number State | MN
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