Healthcare Provider Details

I. General information

NPI: 1073078473
Provider Name (Legal Business Name): TRAUMA LIFE CARE MEDICAL TRANSPORT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2019
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 WATT AVE STE 100
SACRAMENTO CA
95821-6248
US

IV. Provider business mailing address

2829 WATT AVE STE 100
SACRAMENTO CA
95821-6238
US

V. Phone/Fax

Practice location:
  • Phone: 916-368-2222
  • Fax: 916-246-8060
Mailing address:
  • Phone: 916-368-2222
  • Fax: 916-246-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEVEN A ADEOSUN
Title or Position: PRESIDENT
Credential: RN
Phone: 916-368-2222