Healthcare Provider Details

I. General information

NPI: 1811891583
Provider Name (Legal Business Name): PACIFICWAY NEMT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N EUCLID AVE UNIT 219
ONTARIO CA
91762-3474
US

IV. Provider business mailing address

320 N EUCLID AVE UNIT 219
ONTARIO CA
91762-3474
US

V. Phone/Fax

Practice location:
  • Phone: 909-684-5817
  • Fax:
Mailing address:
  • Phone: 909-684-5817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. IBRAHEEM JABBAR
Title or Position: CEO
Credential:
Phone: 909-684-5817