MEDICARE: LIBERTAD TRANSPORTATION CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1265837611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTAD TRANSPORTATION CORPORATION

Provider Business Mailing Address
First Line	:	3648 RED PALM PL
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-1482
Country	:	US
Telephone Number	:	915-478-8455
Fax Number	:	915-345-1161

Provider Business Practice Location Address
First Line	:	3648 RED PALM PL
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-1482
Country	:	US
Telephone Number	:	915-478-8455
Fax Number	:	915-345-1161

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THELMA VILLANUEVA
Credential	:
Telephone Number	:	915-478-8455

Provider Enumeration Date	:	10/28/2014
Last Update Date	:	10/28/2014

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