Provider Demographics
NPI:1265706907
Name:CENTRAL ONE MOBILITY
Entity type:Organization
Organization Name:CENTRAL ONE MOBILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MISS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:BRAGAIS
Authorized Official - Last Name:QUIAOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-808-8140
Mailing Address - Street 1:5250 CLAREMONT AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5700
Mailing Address - Country:US
Mailing Address - Phone:209-475-7953
Mailing Address - Fax:866-768-4102
Practice Address - Street 1:5250 CLAREMONT AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5700
Practice Address - Country:US
Practice Address - Phone:209-475-7953
Practice Address - Fax:866-768-4102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA6800171343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)