Providence Medical Transportation Inc.

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

License

MTN01224F Issued in CA

Legal business name

PROVIDENCE MEDICAL TRANSPORTATION INC.

Practice address

1528 Calle Constancia
Redlands, CA 92373-4813

Phone

(909) 798-7356

Fax

(909) 798-0795

NPI assigned

Dec 22, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Leonardo A. Custodio

Title

President

Phone

(909) 798-7356

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1396800157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1528 CALLE CONSTANCIA",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923734813",
            "telephone_number": "909-798-7356",
            "fax_number": "909-798-0795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1528 CALLE CONSTANCIA",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923734813",
            "telephone_number": "909-798-7356",
            "fax_number": "909-798-0795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE MEDICAL TRANSPORTATION INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CUSTODIO",
        "authorized_official_first_name": "LEONARDO",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-798-7356"
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "CA",
            "license": "MTN01224F",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MTN01224F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Priority Ventures
• Procare Physical Therapy, Inc.
• Mary Catherine Proffitt-Allison, L.C.S.W.
• Prola Home Care LLC
• Protherapy, Inc.
• Tyanna Maggie Puckett
• David Johann Puder, MD
• Brittney Nicole Pugh, M.S., CCC-SLP
• Stephanie Pulido
• Yvonne Pulido

• Non-emergency Medical Transport (VAN) in Redlands, CA
• Providers in Redlands, CA by specialty
• Non-emergency Medical Transport (VAN) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.