Provider Demographics
NPI:1538236765
Name:VANTAGE TRANSPORTS, INC.
Entity type:Organization
Organization Name:VANTAGE TRANSPORTS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOCHOCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-475-0708
Mailing Address - Street 1:460 W LARCH RD STE 12
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95304-1652
Mailing Address - Country:US
Mailing Address - Phone:209-475-0708
Mailing Address - Fax:209-475-0709
Practice Address - Street 1:460 W LARCH RD STE 12
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95304-1652
Practice Address - Country:US
Practice Address - Phone:209-475-0708
Practice Address - Fax:209-475-0709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC-2460479343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN00904FMedicaid