MEDICARE: ELJEAN LLC

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)

General Provider Information

NPI Number	:	1881867075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELJEAN LLC

Provider Business Mailing Address
First Line	:	6540 LUSK BLVD
Second Line	:	SUITE 138 C
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-2766
Country	:	US
Telephone Number	:	858-452-8883
Fax Number	:	858-452-8881

Provider Business Practice Location Address
First Line	:	6540 LUSK BLVD
Second Line	:	STE 138 C
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-2766
Country	:	US
Telephone Number	:	858-452-8883
Fax Number	:	858-452-8881

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. ALFREDO VILLAPANDO OSUNA
Credential	:
Telephone Number	:	858-452-8883

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	08/05/2008

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