Provider Demographics
NPI:1811251028
Name:MY GUARDIAN ANGEL TRANSPORT SERVICES CORP
Entity type:Organization
Organization Name:MY GUARDIAN ANGEL TRANSPORT SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:239-822-0081
Mailing Address - Street 1:5237 SUMMERLIN COMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2158
Mailing Address - Country:US
Mailing Address - Phone:239-822-0081
Mailing Address - Fax:941-882-8267
Practice Address - Street 1:5237 SUMMERLIN COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2158
Practice Address - Country:US
Practice Address - Phone:239-822-0081
Practice Address - Fax:941-882-8267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1002235343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1002235OtherMEDICALTRANSPORT SERVICES