Provider Demographics
NPI:1790422160
Name:MAFAQ LOGISTICS TRANSPORTATION LLC
Entity Type:Organization
Organization Name:MAFAQ LOGISTICS TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MODINAT
Authorized Official - Middle Name:MOYOSORE
Authorized Official - Last Name:ADEDOYIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-452-7230
Mailing Address - Street 1:5408 LARISSA CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-0003
Mailing Address - Country:US
Mailing Address - Phone:757-452-7230
Mailing Address - Fax:
Practice Address - Street 1:5408 LARISSA CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-0003
Practice Address - Country:US
Practice Address - Phone:757-452-7230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAA62643585OtherDRIVER'S LICENCE
VAA60570018OtherDRIVER'S LICENCE