MEDICARE: ONYX HEALTHCARE SERVICES 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	:	1972112688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONYX HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	6161 EL CAJON BLVD STE B293
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-3922
Country	:	US
Telephone Number	:	619-508-7547
Fax Number	:

Provider Business Practice Location Address
First Line	:	5050 E GARFORD ST APT 246
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-5818
Country	:	US
Telephone Number	:	619-508-7547
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YASIR NURADIN ABUKAR
Credential	:
Telephone Number	:	619-508-7547

Provider Enumeration Date	:	07/28/2020
Last Update Date	:	08/12/2020

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