Healthcare Provider Details

I. General information

NPI: 1154801256
Provider Name (Legal Business Name): AMADOR REGIONAL TRANSIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11400 AMERICAN LEGION DR
JACKSON CA
95642-9525
US

IV. Provider business mailing address

11400 AMERICAN LEGION DR
JACKSON CA
95642-9525
US

V. Phone/Fax

Practice location:
  • Phone: 209-267-5079
  • Fax: 209-267-1462
Mailing address:
  • Phone: 209-267-5079
  • Fax: 209-267-1462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number StateCA

VIII. Authorized Official

Name: PATRICIA MAGGIE AMARANT
Title or Position: GENERAL MANAGER
Credential:
Phone: 209-267-5079