Provider Demographics
NPI:1124388590
Name:SAFERIDE EASTVALE CORPORATION
Entity Type:Organization
Organization Name:SAFERIDE EASTVALE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:REYMUNDO
Authorized Official - Middle Name:VIRTUCIO
Authorized Official - Last Name:MITRA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:714-883-1444
Mailing Address - Street 1:6982 MASSY HARRIS WAY
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3429
Mailing Address - Country:US
Mailing Address - Phone:714-883-1444
Mailing Address - Fax:
Practice Address - Street 1:6982 MASSY HARRIS WAY
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-3429
Practice Address - Country:US
Practice Address - Phone:714-883-1444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-20
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR-2012-05737343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)