Provider Demographics
NPI:1093083131
Name:VIA MEDICAL TRANSPORTATION
Entity type:Organization
Organization Name:VIA MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:BLAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIAMBAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-290-7494
Mailing Address - Street 1:63 BOVET RD # 335
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3104
Mailing Address - Country:US
Mailing Address - Phone:650-921-6921
Mailing Address - Fax:
Practice Address - Street 1:1001 BAYHILL DR FL 2
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-3061
Practice Address - Country:US
Practice Address - Phone:650-921-6921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-04
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)