Healthcare Provider Details

I. General information

NPI: 1932665296
Provider Name (Legal Business Name): INFINITI INNOVATIVE HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37600 CENTRAL CT STE 218
NEWARK CA
94560-3456
US

IV. Provider business mailing address

PO BOX 211
NEWARK CA
94560-0211
US

V. Phone/Fax

Practice location:
  • Phone: 510-500-4487
  • Fax: 510-868-0257
Mailing address:
  • Phone: 510-500-4487
  • Fax: 510-868-0257

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: EMEM ITE
Title or Position: COO
Credential: B.SC, MSC (MOT)
Phone: 510-500-4487