Healthcare Provider Details

I. General information

NPI: 1801616693
Provider Name (Legal Business Name): DIVINE AGAPE SHUTTLE RIDES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 N PONDEROSA DR STE B100
CAMARILLO CA
93010-2380
US

IV. Provider business mailing address

2412 N PONDEROSA DR STE B100
CAMARILLO CA
93010-2380
US

V. Phone/Fax

Practice location:
  • Phone: 818-397-0757
  • Fax:
Mailing address:
  • Phone: 818-397-0757
  • Fax:

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: JOHN ISIDORE E MAGLASANG
Title or Position: CEO
Credential:
Phone: 805-616-7203