Provider Demographics
NPI:1558644450
Name:MOONLIGHT MEDICAL TRANSPORTATION SERVICES
Entity Type:Organization
Organization Name:MOONLIGHT MEDICAL TRANSPORTATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:DRIGPAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-779-0475
Mailing Address - Street 1:PO BOX 3543
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93650-3543
Mailing Address - Country:US
Mailing Address - Phone:559-779-0475
Mailing Address - Fax:559-227-6405
Practice Address - Street 1:7625 N 1ST ST
Practice Address - Street 2:#162
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0903
Practice Address - Country:US
Practice Address - Phone:559-779-0475
Practice Address - Fax:559-227-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201113610136343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)