Provider Demographics
NPI:1033202635
Name:PRN MED - TRANSPORT, INC.
Entity Type:Organization
Organization Name:PRN MED - TRANSPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHASTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GABIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-699-5114
Mailing Address - Street 1:41593 WINCHESTER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-4857
Mailing Address - Country:US
Mailing Address - Phone:951-699-5114
Mailing Address - Fax:951-461-8992
Practice Address - Street 1:41593 WINCHESTER RD STE 150
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4860
Practice Address - Country:US
Practice Address - Phone:951-699-5114
Practice Address - Fax:951-461-8992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA011957343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN00980FMedicaid