Provider Demographics
NPI:1053063677
Name:ST AGNES NON-EMERGENCY MEDICAL TRANSPORTATION LLC
Entity Type:Organization
Organization Name:ST AGNES NON-EMERGENCY MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:KIMA
Authorized Official - Last Name:EYONG
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:562-419-5050
Mailing Address - Street 1:30427 DELTA DR
Mailing Address - Street 2:
Mailing Address - City:NUEVO
Mailing Address - State:CA
Mailing Address - Zip Code:92567-9470
Mailing Address - Country:US
Mailing Address - Phone:562-419-5050
Mailing Address - Fax:
Practice Address - Street 1:30427 DELTA DR
Practice Address - Street 2:
Practice Address - City:NUEVO
Practice Address - State:CA
Practice Address - Zip Code:92567-9470
Practice Address - Country:US
Practice Address - Phone:562-419-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1255996658Medicaid