Healthcare Provider Details

I. General information

NPI: 1346922671
Provider Name (Legal Business Name): PEACE RIDE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S GRAND AVE APT 22
ANAHEIM CA
92804-1656
US

IV. Provider business mailing address

120 S GRAND AVE APT 22
ANAHEIM CA
92804-1656
US

V. Phone/Fax

Practice location:
  • Phone: 714-366-9691
  • Fax:
Mailing address:
  • Phone: 714-366-9691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: ISAAC ARAYA
Title or Position: MANAGER
Credential:
Phone: 714-366-9691