Healthcare Provider Details

I. General information

NPI: 1871924589
Provider Name (Legal Business Name): WELL CARE TRANSPORT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2013
Last Update Date: 12/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 WOODLEY AVE. UNIT #205
LAKE BALBOA CA
91406
US

IV. Provider business mailing address

6525 WOODLEY AVE. UNIT #205
LAKE BALBOA CA
91406
US

V. Phone/Fax

Practice location:
  • Phone: 818-646-0701
  • Fax:
Mailing address:
  • Phone: 818-646-0701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: MISS LYDIA D. RUIZ
Title or Position: VICE-PRESIDENT-COO
Credential:
Phone: 818-646-0701