Provider Demographics
NPI:1013515733
Name:MD MEDICAL TRANSPORT
Entity type:Organization
Organization Name:MD MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MEDIE
Authorized Official - Middle Name:PIZARRO
Authorized Official - Last Name:VALDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-635-9239
Mailing Address - Street 1:275 W HOSPITALITY LN STE 322
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3265
Mailing Address - Country:US
Mailing Address - Phone:415-635-9239
Mailing Address - Fax:
Practice Address - Street 1:275 W HOSPITALITY LN STE 322
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3265
Practice Address - Country:US
Practice Address - Phone:415-635-9239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MD MEDICAL TRANSPORT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)