Provider Demographics
NPI:1366860207
Name:ESMERALDA CHAVEZ
Entity Type:Organization
Organization Name:ESMERALDA CHAVEZ
Other - Org Name:SUPREME MEDICAL TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ESMERALDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-508-8560
Mailing Address - Street 1:3160 BONITA RD APT 123
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3269
Mailing Address - Country:US
Mailing Address - Phone:619-598-8560
Mailing Address - Fax:
Practice Address - Street 1:3160 BONITA RD APT 123
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3269
Practice Address - Country:US
Practice Address - Phone:619-508-8560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)