Healthcare Provider Details

I. General information

NPI: 1649674557
Provider Name (Legal Business Name): SECURE RADIO & TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4226 UNIVERSITY AVE
SAN DIEGO CA
92105-1503
US

IV. Provider business mailing address

4226 UNIVERSITY AVE
SAN DIEGO CA
92105-1503
US

V. Phone/Fax

Practice location:
  • Phone: 619-550-1555
  • Fax: 619-550-1888
Mailing address:
  • Phone: 619-550-1555
  • Fax: 619-550-1888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number63669G1
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number18279K1
License Number StateCA

VIII. Authorized Official

Name: MR. ABRAHAM TESSEMA
Title or Position: GENERAL MANAGER
Credential: BS, MBA
Phone: 619-550-1555