Healthcare Provider Details

I. General information

NPI: 1104515956
Provider Name (Legal Business Name): ACTS MOBILE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 ALMADOR TER
ATWATER CA
95301-4202
US

IV. Provider business mailing address

1604 ALMADOR TER
ATWATER CA
95301-4202
US

V. Phone/Fax

Practice location:
  • Phone: 209-489-7408
  • Fax:
Mailing address:
  • Phone: 209-489-7408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RUBY MALDONADO
Title or Position: OWNER/EMPLOYEE
Credential:
Phone: 209-489-7408