Provider Demographics
NPI:1093924524
Name:ST. ALEXIUS TRANSPORTATION
Entity Type:Organization
Organization Name:ST. ALEXIUS TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:AUMENTADO
Authorized Official - Last Name:DE GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:1650-278-0205
Mailing Address - Street 1:333 GELLERT BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2614
Mailing Address - Country:US
Mailing Address - Phone:650-989-8987
Mailing Address - Fax:650-745-8329
Practice Address - Street 1:333 GELLERT BLVD STE 208
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2614
Practice Address - Country:US
Practice Address - Phone:650-989-8987
Practice Address - Fax:650-745-8329
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST ALEXIUS TRANSPORTATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-22
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN01251FOtherMEDI-CAL