Provider Demographics
NPI:1982150421
Name:NDUNGU, MARTIN G (PRESIDENT)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:G
Last Name:NDUNGU
Suffix:
Gender:M
Credentials:PRESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3049 CLEVELAND AVE STE 253
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-7047
Mailing Address - Country:US
Mailing Address - Phone:239-479-1444
Mailing Address - Fax:
Practice Address - Street 1:3049 CLEVELAND AVE STE 253
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7047
Practice Address - Country:US
Practice Address - Phone:239-479-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)