Provider Demographics
NPI:1689239527
Name:MUJICA DOS FRONTERAS
Entity Type:Organization
Organization Name:MUJICA DOS FRONTERAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MUJICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-435-0518
Mailing Address - Street 1:110 N HIGHWAY 86
Mailing Address - Street 2:
Mailing Address - City:AJO
Mailing Address - State:AZ
Mailing Address - Zip Code:85321-1401
Mailing Address - Country:US
Mailing Address - Phone:602-435-0518
Mailing Address - Fax:
Practice Address - Street 1:110 N HIGHWAY 86
Practice Address - Street 2:
Practice Address - City:AJO
Practice Address - State:AZ
Practice Address - Zip Code:85321-1401
Practice Address - Country:US
Practice Address - Phone:602-435-0518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)