Provider Demographics
NPI:1760161376
Name:AGRESOR, VILMA
Entity Type:Individual
Prefix:
First Name:VILMA
Middle Name:
Last Name:AGRESOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2821
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-2821
Mailing Address - Country:US
Mailing Address - Phone:442-800-3945
Mailing Address - Fax:
Practice Address - Street 1:4425 E CAMINO PAROCELA
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-1451
Practice Address - Country:US
Practice Address - Phone:760-333-7066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20028178343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)