Provider Demographics
NPI:1235984766
Name:12925 HESPERIA VICTORVILLE, INC.
Entity Type:Organization
Organization Name:12925 HESPERIA VICTORVILLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-426-0093
Mailing Address - Street 1:2900 BRISTOL STREET BUILDING H SUITE 101
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626
Mailing Address - Country:US
Mailing Address - Phone:949-426-0093
Mailing Address - Fax:949-777-6479
Practice Address - Street 1:2900 BRISTOL STREET BUILDING H SUITE 101
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626
Practice Address - Country:US
Practice Address - Phone:949-426-0093
Practice Address - Fax:949-777-6479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No342000000XTransportation ServicesTransportation Network Company
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi
No347B00000XTransportation ServicesBus
No347E00000XTransportation ServicesTransportation Broker