Healthcare Provider Details

I. General information

NPI: 1265361265
Provider Name (Legal Business Name): COAST 2 COAST CARRIERS 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16041 LA COSTA ALTA DR
MORENO VALLEY CA
92555-5937
US

IV. Provider business mailing address

16041 LA COSTA ALTA DR
MORENO VALLEY CA
92555-5937
US

V. Phone/Fax

Practice location:
  • Phone: 951-438-0918
  • Fax: 951-438-0918
Mailing address:
  • Phone: 951-438-0918
  • Fax: 951-438-0918

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: MS. SHERRY AVERY
Title or Position: PRESIDENT
Credential:
Phone: 951-438-0918