Provider Demographics
NPI:1285340752
Name:VISTA SERENO TRANSPORT SERVICES LLC
Entity type:Organization
Organization Name:VISTA SERENO TRANSPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMINIQUE JOHN
Authorized Official - Middle Name:ORCA
Authorized Official - Last Name:MASE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:619-405-3586
Mailing Address - Street 1:2725 VISTA SERENO CT
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-3436
Mailing Address - Country:US
Mailing Address - Phone:619-405-3586
Mailing Address - Fax:619-467-7289
Practice Address - Street 1:2725 VISTA SERENO CT
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-3436
Practice Address - Country:US
Practice Address - Phone:619-405-3586
Practice Address - Fax:619-467-7289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)