Healthcare Provider Details

I. General information

NPI: 1811742497
Provider Name (Legal Business Name): JMK DEPENDABLE TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 DAHLIA AVE
IMPERIAL BEACH CA
91932-2020
US

IV. Provider business mailing address

655 DAHLIA AVE
IMPERIAL BEACH CA
91932-2020
US

V. Phone/Fax

Practice location:
  • Phone: 619-773-5710
  • Fax:
Mailing address:
  • Phone: 619-773-5710
  • 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: MICHELLE AGUSTIN
Title or Position: OWNER
Credential:
Phone: 619-773-5710