Provider Demographics
NPI:1477093128
Name:K. C. MEDIVANS INC
Entity Type:Organization
Organization Name:K. C. MEDIVANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:CECILIA
Authorized Official - Last Name:CUADRA
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:562-273-0390
Mailing Address - Street 1:PO BOX 1783
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91793-1783
Mailing Address - Country:US
Mailing Address - Phone:562-273-0390
Mailing Address - Fax:562-273-0332
Practice Address - Street 1:2925 ATHEL DR
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-4304
Practice Address - Country:US
Practice Address - Phone:562-273-0390
Practice Address - Fax:562-273-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)