Provider Demographics
NPI:1104719335
Name:KVL MED TRANSPORT LLC
Entity type:Organization
Organization Name:KVL MED TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-538-8334
Mailing Address - Street 1:12201 DERBY ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-2779
Mailing Address - Country:US
Mailing Address - Phone:802-503-9898
Mailing Address - Fax:
Practice Address - Street 1:1481 W 7TH ST APT 9
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-7058
Practice Address - Country:US
Practice Address - Phone:602-538-8334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-28
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
No347C00000XTransportation ServicesPrivate Vehicle