Provider Demographics
NPI:1861684839
Name:CONNECTION MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:CONNECTION MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:RICARDO
Authorized Official - Last Name:ELIZARRARAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-477-2042
Mailing Address - Street 1:2504 TRANSPORTATION AVE STE E
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-8524
Mailing Address - Country:US
Mailing Address - Phone:619-477-2042
Mailing Address - Fax:619-477-5055
Practice Address - Street 1:2504 TRANSPORTATION AVE STE E
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-8524
Practice Address - Country:US
Practice Address - Phone:619-477-2042
Practice Address - Fax:619-477-5055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)