Provider Demographics
NPI:1285369132
Name:TARANGO, EDDIE (N/A)
Entity type:Individual
Prefix:MR
First Name:EDDIE
Middle Name:
Last Name:TARANGO
Suffix:
Gender:M
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4135 BLANCHARD ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90063-1301
Mailing Address - Country:US
Mailing Address - Phone:323-331-0792
Mailing Address - Fax:
Practice Address - Street 1:4135 BLANCHARD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90063-1301
Practice Address - Country:US
Practice Address - Phone:323-331-0792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)