Healthcare Provider Details

I. General information

NPI: 1851850473
Provider Name (Legal Business Name): RAM'S ROOF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12861 MEDITERRANEAN DR
ETIWANDA CA
91739-8954
US

IV. Provider business mailing address

12861 MEDITERRANEAN DR
ETIWANDA CA
91739-8954
US

V. Phone/Fax

Practice location:
  • Phone: 909-559-3034
  • Fax:
Mailing address:
  • Phone: 909-559-3034
  • 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 Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. VIVEK SHARMA
Title or Position: PRISEDENT
Credential:
Phone: 909-559-3034