Provider Demographics
NPI:1043069933
Name:DESERT STAR MED-TRANSPORT LLC
Entity type:Organization
Organization Name:DESERT STAR MED-TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:N
Authorized Official - Last Name:VASQUEZ MORATAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-567-5584
Mailing Address - Street 1:33350 CATHEDRAL CANYON DR APT 9
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-4534
Mailing Address - Country:US
Mailing Address - Phone:760-567-5584
Mailing Address - Fax:
Practice Address - Street 1:33350 CATHEDRAL CANYON DR APT 9
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-4534
Practice Address - Country:US
Practice Address - Phone:760-567-5584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)