Healthcare Provider Details

I. General information

NPI: 1407637788
Provider Name (Legal Business Name): BMM NON MEDICAL TRASPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3517 MARCONI AVE STE 107C1
SACRAMENTO CA
95821-5328
US

IV. Provider business mailing address

3517 MARCONI AVE STE 3517
SACRAMENTO CA
95821-5328
US

V. Phone/Fax

Practice location:
  • Phone: 916-885-9054
  • Fax: 877-496-9976
Mailing address:
  • Phone: 916-885-9054
  • Fax: 877-496-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MASRESHAW TEBEJE
Title or Position: OWNER
Credential:
Phone: 916-855-9054