MEDICARE: COACHELLA VALLEY MT 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	:	1659065050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COACHELLA VALLEY MT LLC

Provider Business Mailing Address
First Line	:	57 S WILLIAMS RD
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92264-1551
Country	:	US
Telephone Number	:	760-219-9263
Fax Number	:

Provider Business Practice Location Address
First Line	:	574 S WILLIAMS RD STE B
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92264-1551
Country	:	US
Telephone Number	:	760-219-9263
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. LARRY F VILLALOBOS
Credential	:
Telephone Number	:	760-424-6574

Provider Enumeration Date	:	06/07/2023
Last Update Date	:	12/11/2025

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