Provider Demographics
NPI:1184889693
Name:SOUTHERN CALIFORNIA MEDICAL TRASNSPORT
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA MEDICAL TRASNSPORT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:RUEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-374-5334
Mailing Address - Street 1:8700 HAVEN AVE STE 2113
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730
Mailing Address - Country:US
Mailing Address - Phone:909-563-4900
Mailing Address - Fax:909-980-6141
Practice Address - Street 1:8700 HAVEN AVE STE 2113
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:909-374-5334
Practice Address - Fax:909-980-6141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)