Provider Demographics
NPI:1629580634
Name:ABC NON-EMERGENCY MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:ABC NON-EMERGENCY MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/OWNER/PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:MANTUA
Authorized Official - Last Name:BELLEZA
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:559-691-9317
Mailing Address - Street 1:4052 W FENDER AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-4692
Mailing Address - Country:US
Mailing Address - Phone:559-691-9317
Mailing Address - Fax:
Practice Address - Street 1:4052 W FENDER AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-4692
Practice Address - Country:US
Practice Address - Phone:559-691-9317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)