Provider Demographics
NPI:1902880917
Name:SAN DIEGO MEDICAL TRANSPORT, INC.
Entity Type:Organization
Organization Name:SAN DIEGO MEDICAL TRANSPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MISAEL
Authorized Official - Middle Name:LEOBARDO
Authorized Official - Last Name:CORONEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-531-8900
Mailing Address - Street 1:864 34TH STREET
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-3310
Mailing Address - Country:US
Mailing Address - Phone:619-531-8900
Mailing Address - Fax:619-531-8910
Practice Address - Street 1:864 34TH STREET
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-3310
Practice Address - Country:US
Practice Address - Phone:619-531-8900
Practice Address - Fax:619-531-8910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN01274FMedicaid