Healthcare Provider Details

I. General information

NPI: 1740090547
Provider Name (Legal Business Name): SJC TRANSIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 NELSON AVE UNIT B
REDONDO BEACH CA
90278
US

IV. Provider business mailing address

2105 NELSON AVE UNIT B
REDONDO BEACH CA
90278-2407
US

V. Phone/Fax

Practice location:
  • Phone: 310-340-9306
  • Fax:
Mailing address:
  • Phone: 310-340-9306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHAKEEL BASHIR
Title or Position: OWNER
Credential:
Phone: 310-340-9306