Healthcare Provider Details

I. General information

NPI: 1609547108
Provider Name (Legal Business Name): RYDER ON THE GO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 09/23/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6709 LA TIJERA BLVD STE 533
LOS ANGELES CA
90045-2017
US

IV. Provider business mailing address

6709 LA TIJERA BLVD STE 533
LOS ANGELES CA
90045-2017
US

V. Phone/Fax

Practice location:
  • Phone: 323-336-3717
  • Fax:
Mailing address:
  • Phone: 323-336-3717
  • 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 BURTON
Title or Position: OWNER
Credential:
Phone: 323-336-3717