Provider Demographics
NPI:1396844031
Name:MARIA CASTILLO FIRST CLASS MOBILITY
Entity Type:Organization
Organization Name:MARIA CASTILLO FIRST CLASS MOBILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:CITY BUS LIC
Authorized Official - Phone:916-670-1744
Mailing Address - Street 1:PO BOX 580072
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-0002
Mailing Address - Country:US
Mailing Address - Phone:916-670-1744
Mailing Address - Fax:916-669-9379
Practice Address - Street 1:2132 CERMAK WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7122
Practice Address - Country:US
Practice Address - Phone:916-670-1744
Practice Address - Fax:916-669-9379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0800005156343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN01120FOtherMEDICAL TRANSPORTATION