MEDICARE: MARIA CASTILLO FIRST CLASS MOBILITY

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)	0800005156	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MTN01120F	OTHER	CA	MEDICAL TRANSPORTATION

General Provider Information

NPI Number	:	1396844031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIA CASTILLO FIRST CLASS MOBILITY

Provider Business Mailing Address
First Line	:	PO BOX 580072
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-0002
Country	:	US
Telephone Number	:	916-670-1744
Fax Number	:	916-669-9379

Provider Business Practice Location Address
First Line	:	2132 CERMAK WAY
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-7122
Country	:	US
Telephone Number	:	916-670-1744
Fax Number	:	916-669-9379

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MARIA CASTILLO
Credential	:	CITY BUS. LIC
Telephone Number	:	916-670-1744

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	06/16/2008

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