Provider Demographics
NPI:1699093765
Name:MEDICAL LOGISTICS MANAGEMENT INC.
Entity type:Organization
Organization Name:MEDICAL LOGISTICS MANAGEMENT INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-754-6755
Mailing Address - Street 1:2082 OTAY LAKES RD STE 202
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1367
Mailing Address - Country:US
Mailing Address - Phone:619-754-6755
Mailing Address - Fax:619-330-4551
Practice Address - Street 1:2082 OTAY LAKES RD STE 202
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-1367
Practice Address - Country:US
Practice Address - Phone:619-754-6755
Practice Address - Fax:619-330-4551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC29931813416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport