Healthcare Provider Details

I. General information

NPI: 1780212019
Provider Name (Legal Business Name): EXPRESS MEDICAL TRANSIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S GLASSELL ST # 104B
ORANGE CA
92866-3004
US

IV. Provider business mailing address

2315 W PALM AVE
ORANGE CA
92868-1912
US

V. Phone/Fax

Practice location:
  • Phone: 714-396-4965
  • Fax:
Mailing address:
  • Phone: 714-396-4965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: JUAN CARLOS ARAUJO MUNOZ
Title or Position: MANAGER
Credential:
Phone: 714-396-4965