MEDICARE: MR. KHALIL N TOTAH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)		CA

General Provider Information

NPI Number	:	1689423402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KHALIL N TOTAH

Provider Business Mailing Address
First Line	:	5037 FOXBORO DR
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-1416
Country	:	US
Telephone Number	:	510-330-8640
Fax Number	:

Provider Business Practice Location Address
First Line	:	5037 FOXBORO DR
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-1416
Country	:	US
Telephone Number	:	510-330-8640
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2024
Last Update Date	:	05/14/2024

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