Provider Demographics
NPI:1689213274
Name:VEGA TRANSPORT CA LLC
Entity Type:Organization
Organization Name:VEGA TRANSPORT CA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:FANGONIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-327-0266
Mailing Address - Street 1:275 W HOSPITALITY LN STE 322
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3265
Mailing Address - Country:US
Mailing Address - Phone:909-222-6798
Mailing Address - Fax:909-296-7200
Practice Address - Street 1:275 W HOSPITALITY LN STE 322
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3265
Practice Address - Country:US
Practice Address - Phone:909-222-6798
Practice Address - Fax:909-296-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)