Provider Demographics
NPI:1174088876
Name:VOS, GALINA VICTOROVNA
Entity type:Individual
Prefix:
First Name:GALINA
Middle Name:VICTOROVNA
Last Name:VOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GALINA
Other - Middle Name:VICTOROVNA
Other - Last Name:VOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1114 DEWHURST ST
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-1557
Mailing Address - Country:US
Mailing Address - Phone:941-258-2189
Mailing Address - Fax:941-889-7089
Practice Address - Street 1:1114 DEWHURST ST
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-1557
Practice Address - Country:US
Practice Address - Phone:941-258-2189
Practice Address - Fax:941-889-7089
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25889343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)