Organization
CARLOS A. GRANDE
Active
Other names
West Coast Mobility
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARLOS ALBERTO GRANDE JR. (OWNER)
(415) 584-2073
Entity
Organization
Contact information
Practice address
69 SAN JUAN AVE, SAN FRANCISCO, CA 94112-2615
(415) 584-2073
Mailing address
69 SAN JUAN AVE, SAN FRANCISCO, CA 94112-2615
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
MTN01009F
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MTN01009F
MEDI-CAL PROVIDER NUMBER
CA
Enumeration date
05/21/2007
Last updated
07/11/2007
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