Provider Demographics
NPI:1285026112
Name:MISSION PALM'S TRANSPORTATION LLC
Entity Type:Organization
Organization Name:MISSION PALM'S TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:IDLLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-942-4414
Mailing Address - Street 1:5922 RANCHO MISSION RD UNIT 66
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-2518
Mailing Address - Country:US
Mailing Address - Phone:619-942-4414
Mailing Address - Fax:
Practice Address - Street 1:4265 FAIRMOUNT AVE STE 120A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-6401
Practice Address - Country:US
Practice Address - Phone:619-942-4414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle