Basic Information
| Provider Information | |||||||||
| NPI: | 1558644450 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOONLIGHT MEDICAL TRANSPORTATION SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3543 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936503543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597790475 | ||||||||
| FaxNumber: | 5592276405 | ||||||||
| Practice Location | |||||||||
| Address1: | 7625 N 1ST ST | ||||||||
| Address2: | #162 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937200903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597790475 | ||||||||
| FaxNumber: | 5592276405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2011 | ||||||||
| LastUpdateDate: | 09/27/2011 | ||||||||
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| AuthorizedOfficialLastName: | DRIGPAL | ||||||||
| AuthorizedOfficialFirstName: | SUNIL | ||||||||
| AuthorizedOfficialMiddleName: | KUMAR | ||||||||
| AuthorizedOfficialTitleorPosition: | CO-OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5597790475 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 343900000X | 201113610136 | CA | Y | Transportation Services | Non-emergency Medical Transport (VAN) |
No ID Information.