Healthcare Provider Details

I. General information

NPI: 1417447541
Provider Name (Legal Business Name): BLU TRANSPORT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 WHITETHORNE DR
SAN JOSE CA
95128-4243
US

IV. Provider business mailing address

1821 S BASCOM AVE #151
CAMPBELL CA
95008-2357
US

V. Phone/Fax

Practice location:
  • Phone: 408-721-2229
  • Fax:
Mailing address:
  • Phone: 408-721-2229
  • 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: DARIUS DORIA
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 408-721-2229