Provider Demographics
NPI:1457997835
Name:PROICON TRANSPORTATION LLC
Entity Type:Organization
Organization Name:PROICON TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ROQUE
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-420-8117
Mailing Address - Street 1:337 INNISFREE DR
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4359
Mailing Address - Country:US
Mailing Address - Phone:650-420-8117
Mailing Address - Fax:800-783-2084
Practice Address - Street 1:337 INNISFREE DR
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4359
Practice Address - Country:US
Practice Address - Phone:650-420-8117
Practice Address - Fax:800-783-2084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)