Provider Demographics
NPI:1497845846
Name:MALANA, ROGELIO
Entity type:Individual
Prefix:
First Name:ROGELIO
Middle Name:
Last Name:MALANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31141 OLD TRAIL CIR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-6272
Mailing Address - Country:US
Mailing Address - Phone:619-482-2255
Mailing Address - Fax:619-482-2256
Practice Address - Street 1:31141 OLD TRAIL CIR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-6272
Practice Address - Country:US
Practice Address - Phone:619-482-2255
Practice Address - Fax:619-482-2256
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44789386343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)