Provider Demographics
NPI:1144885765
Name:COAST MEDICAL TRANSPORT, INC
Entity type:Organization
Organization Name:COAST MEDICAL TRANSPORT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GIOVANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLOUKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-729-2229
Mailing Address - Street 1:8733 N MAGNOLIA AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-4524
Mailing Address - Country:US
Mailing Address - Phone:866-502-6278
Mailing Address - Fax:
Practice Address - Street 1:8733 N MAGNOLIA AVE STE 120
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-4524
Practice Address - Country:US
Practice Address - Phone:619-258-4274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance