Healthcare Provider Details

I. General information

NPI: 1063709350
Provider Name (Legal Business Name): JACOB TRANSPORTATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5052 N 35TH DR
PHOENIX AZ
85019-2702
US

IV. Provider business mailing address

5052 N 35 TH DR
PHOENIX AZ
85019
US

V. Phone/Fax

Practice location:
  • Phone: 602-866-7777
  • Fax: 602-866-7786
Mailing address:
  • Phone: 602-866-7777
  • Fax: 602-866-7786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number20141323
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number20141323
License Number StateAZ

VIII. Authorized Official

Name: MR. JACOB YOUSIF ABUALOKUL JR.
Title or Position: OWNER/ PRESIDNET
Credential:
Phone: 602-866-7777