Provider Demographics
NPI:1952847071
Name:GISELLE MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:GISELLE MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALOMON
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-333-4662
Mailing Address - Street 1:PO BOX 3013
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92235-3013
Mailing Address - Country:US
Mailing Address - Phone:760-333-4662
Mailing Address - Fax:760-832-8739
Practice Address - Street 1:31055 AVENIDA DEL PADRE
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-3006
Practice Address - Country:US
Practice Address - Phone:760-333-4662
Practice Address - Fax:760-832-8739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA3645238343900000X
CAE1525643343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)