Provider Demographics
NPI:1043924079
Name:WTL TRANSPORT CORP
Entity Type:Organization
Organization Name:WTL TRANSPORT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DUQUE-DOPORTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-626-3802
Mailing Address - Street 1:154 JUNIPERO SERRA DR
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1209
Mailing Address - Country:US
Mailing Address - Phone:626-877-2791
Mailing Address - Fax:
Practice Address - Street 1:154 JUNIPERO SERRA DR
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1209
Practice Address - Country:US
Practice Address - Phone:626-877-2791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty