Provider Demographics
NPI:1043871940
Name:CLOUD 9 MEDICAL TRANSPORT LLC
Entity type:Organization
Organization Name:CLOUD 9 MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARON
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:619-600-9595
Mailing Address - Street 1:6071 GOLD SPIRIT ST
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-0989
Mailing Address - Country:US
Mailing Address - Phone:951-536-6573
Mailing Address - Fax:
Practice Address - Street 1:6071 GOLD SPIRIT ST
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-0989
Practice Address - Country:US
Practice Address - Phone:951-536-6573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-22
Last Update Date:2019-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)