Provider Demographics
NPI:1952651028
Name:FIRST RESPONSE MEDICAL TRANSPORTATION CENTRAL VALLEY
Entity Type:Organization
Organization Name:FIRST RESPONSE MEDICAL TRANSPORTATION CENTRAL VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:VANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-453-1509
Mailing Address - Street 1:2357 S PLAYA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-6360
Mailing Address - Country:US
Mailing Address - Phone:559-453-1509
Mailing Address - Fax:
Practice Address - Street 1:2513 E LAMONA AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703
Practice Address - Country:US
Practice Address - Phone:559-453-1509
Practice Address - Fax:559-453-1509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410645343900000X
CABL10117932343900000X
CA9878343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)