Healthcare Provider Details

I. General information

NPI: 1811767379
Provider Name (Legal Business Name): SUBLIME NON EMERGENCY MEDICAL TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 TRIPLEFIN WAY
ELK GROVE CA
95757-6442
US

IV. Provider business mailing address

8260 TRIPLEFIN WAY
ELK GROVE CA
95757-6442
US

V. Phone/Fax

Practice location:
  • Phone: 951-858-2377
  • Fax:
Mailing address:
  • Phone: 951-858-2377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: EDIDIONG UKPONG
Title or Position: ORGANIZER/MEMBER
Credential:
Phone: 951-858-2377