MEDICARE: COACHELLA VMT 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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1598628497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COACHELLA VMT LLC

Provider Business Mailing Address
First Line	:	574 WILLIAMS RD STE B
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92264-1551
Country	:	US
Telephone Number	:	760-424-6574
Fax Number	:

Provider Business Practice Location Address
First Line	:	574 WILLIAMS RD STE B
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92264-1551
Country	:	US
Telephone Number	:	760-424-6574
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LARRY FEDERICO VILLALOBOS
Credential	:
Telephone Number	:	760-424-6574

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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