Provider Demographics
NPI:1497633887
Name:IMMACULATE MEDICAL TRANSPORTATION LLC
Entity type:Organization
Organization Name:IMMACULATE MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JADE
Authorized Official - Middle Name:A
Authorized Official - Last Name:INGUITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-414-8460
Mailing Address - Street 1:16579 SIR BARTON WAY
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-2535
Mailing Address - Country:US
Mailing Address - Phone:714-414-8460
Mailing Address - Fax:
Practice Address - Street 1:16579 SIR BARTON WAY
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-2535
Practice Address - Country:US
Practice Address - Phone:714-414-8460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)