MEDICARE: USTANO K MCVEY

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)	P12177	CA

General Provider Information

NPI Number	:	1477109858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	USTANO K MCVEY

Provider Business Mailing Address
First Line	:	521 W OAK ST
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95203-2815
Country	:	US
Telephone Number	:	415-571-3511
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 W OAK ST
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95203-2815
Country	:	US
Telephone Number	:	415-571-3511
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2019
Last Update Date	:	08/12/2019

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Directions to “ USTANO K MCVEY ” Practice Location

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