Healthcare Provider Details

I. General information

NPI: 1649069428
Provider Name (Legal Business Name): LAE EXPRESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 LONE TREE WAY # 360
ANTIOCH CA
94509-6018
US

IV. Provider business mailing address

3710 LONE TREE WAY # 360
ANTIOCH CA
94509-6018
US

V. Phone/Fax

Practice location:
  • Phone: 925-420-8467
  • Fax: 925-204-6708
Mailing address:
  • Phone: 925-420-8467
  • Fax: 925-204-6708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: LIBRA COSTON
Title or Position: CEO/OWNER
Credential:
Phone: 925-420-8467