Healthcare Provider Details

I. General information

NPI: 1386565752
Provider Name (Legal Business Name): PATHWAY MEDICAL TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9747 BUSINESSPARK AVE STE 255
SAN DIEGO CA
92131-1661
US

IV. Provider business mailing address

9747 BUSINESSPARK AVE STE 255
SAN DIEGO CA
92131-1661
US

V. Phone/Fax

Practice location:
  • Phone: 619-771-2691
  • Fax:
Mailing address:
  • Phone: 619-771-2691
  • Fax:

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: MOHAMED HAJI NOOR
Title or Position: OWNER
Credential:
Phone: 619-771-2691