Provider Demographics
NPI:1871372508
Name:VISTA TRANS LLC
Entity type:Organization
Organization Name:VISTA TRANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHALVA
Authorized Official - Middle Name:
Authorized Official - Last Name:LORTKIPANIDZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-862-8814
Mailing Address - Street 1:2150 N 1ST ST UNIT 471
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-2020
Mailing Address - Country:US
Mailing Address - Phone:650-862-8814
Mailing Address - Fax:
Practice Address - Street 1:2150 N 1ST ST UNIT 471
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-2020
Practice Address - Country:US
Practice Address - Phone:650-862-8814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)