Provider Demographics
NPI:1144472929
Name:GOA MEDICAL TRANSPORTATION, INC
Entity type:Organization
Organization Name:GOA MEDICAL TRANSPORTATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:ADALBERTO
Authorized Official - Middle Name:E
Authorized Official - Last Name:OLAZABAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-709-7489
Mailing Address - Street 1:454 E 46TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1862
Mailing Address - Country:US
Mailing Address - Phone:786-709-7489
Mailing Address - Fax:786-953-7603
Practice Address - Street 1:454 E 46TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1862
Practice Address - Country:US
Practice Address - Phone:786-709-7489
Practice Address - Fax:786-953-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-12
Last Update Date:2008-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6536362343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)