Provider Demographics
NPI:1518346493
Name:LIFE CARE MEDICAL TRANSPORT, LLC
Entity Type:Organization
Organization Name:LIFE CARE MEDICAL TRANSPORT, LLC
Other - Org Name:LIFE CARE MEDICAL TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-277-1535
Mailing Address - Street 1:727 E SAN YSIDRO BLVD # 148
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-3144
Mailing Address - Country:US
Mailing Address - Phone:619-277-1535
Mailing Address - Fax:
Practice Address - Street 1:727 E SAN YSIDRO BLVD # 148
Practice Address - Street 2:
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173-3144
Practice Address - Country:US
Practice Address - Phone:619-277-1535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-25
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN798343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)