Healthcare Provider Details

I. General information

NPI: 1518821545
Provider Name (Legal Business Name): CANYON CARE TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2317 PENDIO
IRVINE CA
92620-1762
US

IV. Provider business mailing address

2317 PENDIO
IRVINE CA
92620-1762
US

V. Phone/Fax

Practice location:
  • Phone: 949-662-4182
  • Fax: 949-662-4182
Mailing address:
  • Phone: 949-662-4182
  • Fax: 949-662-4182

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: AHMED THAKEB
Title or Position: OWNER
Credential:
Phone: 949-662-4182