Healthcare Provider Details

I. General information

NPI: 1275835670
Provider Name (Legal Business Name): EXPRESS TRANSPORTATION SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6782 COLUMBUS ST
RIVERSIDE CA
92504-1118
US

IV. Provider business mailing address

6782 COLUMBUS ST
RIVERSIDE CA
92504-1118
US

V. Phone/Fax

Practice location:
  • Phone: 951-222-2291
  • Fax: 951-369-3049
Mailing address:
  • Phone: 951-222-2291
  • Fax: 951-369-3049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberTCP0021897
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number3446000000X
License Number StateCA

VIII. Authorized Official

Name: MR. MESFIN SHAWELL
Title or Position: PRESIDENT
Credential:
Phone: 951-222-2291