Healthcare Provider Details

I. General information

NPI: 1447951421
Provider Name (Legal Business Name): BLACK WHITE LOGISTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 RUTLAND DR UNIT 22
CARMICHAEL CA
95608-0515
US

IV. Provider business mailing address

6020 RUTLAND DR UNIT 22
CARMICHAEL CA
95608-0515
US

V. Phone/Fax

Practice location:
  • Phone: 650-219-6502
  • 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 Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name: MUSTAFA ALIAKBR
Title or Position: OWNER
Credential:
Phone: 650-219-6502