Provider Demographics
NPI:1881443471
Name:MENDEZ MEDICAL TRANSPORT LLC
Entity type:Organization
Organization Name:MENDEZ MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GENESIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-662-9565
Mailing Address - Street 1:1430 E LYNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-7047
Mailing Address - Country:US
Mailing Address - Phone:909-662-9565
Mailing Address - Fax:
Practice Address - Street 1:188 N EUCLID AVE STE 200B
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6092
Practice Address - Country:US
Practice Address - Phone:909-662-9565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle