Provider Demographics
NPI:1750827192
Name:ECUADORIAN EXPRESS LLC
Entity Type:Organization
Organization Name:ECUADORIAN EXPRESS LLC
Other - Org Name:ECUADORIAN TAXI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANNAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ARTURO
Authorized Official - Last Name:ILLISACA
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:612-788-0607
Mailing Address - Street 1:3905 VAN BUREN ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-3956
Mailing Address - Country:US
Mailing Address - Phone:612-788-0607
Mailing Address - Fax:
Practice Address - Street 1:3905 VAN BUREN ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55421-3956
Practice Address - Country:US
Practice Address - Phone:612-788-0607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL256 50022344600000X
MNL25650022344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi