Healthcare Provider Details

I. General information

NPI: 1265103915
Provider Name (Legal Business Name): GUBARA TRANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 N 31ST AVE STE D321
PHOENIX AZ
85051-1701
US

IV. Provider business mailing address

4201 W SURREY AVE
PHOENIX AZ
85029-1974
US

V. Phone/Fax

Practice location:
  • Phone: 623-383-0910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateNULL

VIII. Authorized Official

Name: KHALID GUBARA
Title or Position: MANAGER
Credential:
Phone: 623-383-0910