Organization
PROVIDENCE MEDICAL TRANSPORTATION INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEONARDO A. CUSTODIO (PRESIDENT)
(909) 798-7356
Entity
Organization
Contact information
Practice address
1528 CALLE CONSTANCIA, REDLANDS, CA 92373-4813
(909) 798-7356
(909) 798-0795
Mailing address
1528 CALLE CONSTANCIA, REDLANDS, CA 92373-4813
(909) 798-7356
(909) 798-0795
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
MTN01224F
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MTN01224F
—
CA
Enumeration date
12/22/2006
Last updated
08/22/2020
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