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General NPI Number Information
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NPI Number | 1952955262
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Entity Type | Organization
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Legal Business Name | LUCKY 7 TAXI
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Dates
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Enumeration Date | 07/25/2019
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Last Update Date | 07/25/2019
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Provider Practice Location Address
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Address Line | 5225 PENTECOST DR STE 18
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City | MODESTO
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State | CA
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Zip | 95356-9286
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Country | US
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Telephone | 209-402-4203
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Fax | 209-575-7004
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Provider Business Mailing Address
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Address Line | 4304 GASTONBURY CT
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City | SALIDA
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State | CA
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Zip | 95368-9739
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Country | US
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Telephone | 209-402-4203
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HELDER GABRIEL FREITAS
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Credential |
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Telephone | 209-402-4203
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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 |
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License Number State |
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