MEDICARE: ESTIOKO TRANSPORT SERVICES, LLC

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	347C00000X	Private Vehicle		TX

General Provider Information

NPI Number	:	1508245861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESTIOKO TRANSPORT SERVICES, LLC

Provider Business Mailing Address
First Line	:	1186 FOREST BLUFF TRL
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-3913
Country	:	US
Telephone Number	:	512-248-9133
Fax Number	:

Provider Business Practice Location Address
First Line	:	1186 FOREST BLUFF TRL
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-3913
Country	:	US
Telephone Number	:	512-248-9133
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	MS. MALOLITA SALVACION ESTIOKO
Credential	:
Telephone Number	:	913-244-2531

Provider Enumeration Date	:	05/20/2015
Last Update Date	:	05/20/2015

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