Healthcare Provider Details

I. General information

NPI: 1295251502
Provider Name (Legal Business Name): MED-CAL EXPRESS TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 CROOKED TRAIL RD
CHULA VISTA CA
91914-4143
US

IV. Provider business mailing address

2405 CROOKED TRAIL RD
CHULA VISTA CA
91914-4143
US

V. Phone/Fax

Practice location:
  • Phone: 858-405-1125
  • Fax:
Mailing address:
  • Phone: 858-405-1125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ISMAIL AHMED ALI
Title or Position: PRESIDENT
Credential:
Phone: 858-405-1125