1134887318 NPI number — FRONTLINE MEDICAL TRANSPORTATION LLC

Table of content: JEAN WILSON MUTAMBUZE MD (NPI 1518427905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134887318 NPI number — FRONTLINE MEDICAL TRANSPORTATION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRONTLINE MEDICAL TRANSPORTATION LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134887318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6358 ECHO HILLS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FONTANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92336-5838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-680-0537
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8608 UTICA AVE STE 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANCHO CUCAMONGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91730-4877
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-204-5205
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2021

Additional Information

Authorized Official

Authorized Official Last Name:
SMADI
Authorized Official First Name:
ALHASAN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
909-680-0537

Provider Taxonomy Codes

  • Taxonomy code: 342000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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