Provider Demographics
NPI:1255109294
Name:CRISTALINE WEST TRANSPORTATION
Entity type:Organization
Organization Name:CRISTALINE WEST TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTALINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-904-1245
Mailing Address - Street 1:1401 N MAIN ST. UNIT 5503
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32627
Mailing Address - Country:US
Mailing Address - Phone:561-904-1245
Mailing Address - Fax:
Practice Address - Street 1:1401 N MAIN ST. UNIT 5503
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32627
Practice Address - Country:US
Practice Address - Phone:561-904-1245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRISTALINE WEST TRANSPORTATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company