Provider Demographics
NPI:1265837611
Name:LIBERTAD TRANSPORTATION CORPORATION
Entity Type:Organization
Organization Name:LIBERTAD TRANSPORTATION CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-478-8455
Mailing Address - Street 1:3648 RED PALM PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-1482
Mailing Address - Country:US
Mailing Address - Phone:915-478-8455
Mailing Address - Fax:915-345-1161
Practice Address - Street 1:3648 RED PALM PL
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-1482
Practice Address - Country:US
Practice Address - Phone:915-478-8455
Practice Address - Fax:915-345-1161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)