Provider Demographics
NPI:1003695552
Name:DISTINGUISHED SENIOR TRANSPORTATION
Entity Type:Organization
Organization Name:DISTINGUISHED SENIOR TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NORIEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-804-6098
Mailing Address - Street 1:19702 OAK GREEN CT
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-1215
Mailing Address - Country:US
Mailing Address - Phone:281-804-6098
Mailing Address - Fax:
Practice Address - Street 1:19702 OAK GREEN CT
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-1215
Practice Address - Country:US
Practice Address - Phone:281-804-6098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)