Provider Demographics
NPI:1700610342
Name:LONGORIA, JOSE MANUEL
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:MANUEL
Last Name:LONGORIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:MANUEL
Other - Last Name:LONGORIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5217 STATE RD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459
Mailing Address - Country:US
Mailing Address - Phone:708-200-9924
Mailing Address - Fax:
Practice Address - Street 1:5217 STATE RD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459
Practice Address - Country:US
Practice Address - Phone:708-200-9924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)