Healthcare Provider Details

I. General information

NPI: 1710704572
Provider Name (Legal Business Name): DIVERSE MED COURIERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15699 HAMMETT CT
MORENO VALLEY CA
92555-4993
US

IV. Provider business mailing address

3651 LINDELL RD STE D854
LAS VEGAS NV
89103-1254
US

V. Phone/Fax

Practice location:
  • Phone: 800-406-5012
  • Fax:
Mailing address:
  • Phone: 951-655-0707
  • 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: MR. WENDELL WADE ANTOINE SR.
Title or Position: CEO
Credential:
Phone: 951-655-0707