Provider Demographics
NPI:1871987529
Name:BROCKTON MEDICAL TRANSPORT, LLC
Entity type:Organization
Organization Name:BROCKTON MEDICAL TRANSPORT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RUFINO
Authorized Official - Middle Name:CARREON
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-374-0030
Mailing Address - Street 1:5670 SCHAEFER AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-9005
Mailing Address - Country:US
Mailing Address - Phone:951-374-0004
Mailing Address - Fax:951-374-0005
Practice Address - Street 1:5670 SCHAEFER AVE
Practice Address - Street 2:SUITE L
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-9005
Practice Address - Country:US
Practice Address - Phone:951-374-0004
Practice Address - Fax:951-374-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)