Provider Demographics
NPI:1306729710
Name:ITZA TRANSPORT LLC
Entity type:Organization
Organization Name:ITZA TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRAINERD
Authorized Official - Middle Name:EDMILSON
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:442-677-9410
Mailing Address - Street 1:2786 E TAHQUITZ CANYON WAY APT 101
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7058
Mailing Address - Country:US
Mailing Address - Phone:442-677-9410
Mailing Address - Fax:
Practice Address - Street 1:655 N PALM CANYON DR STE 216
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5529
Practice Address - Country:US
Practice Address - Phone:442-677-9410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-31
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)