Healthcare Provider Details

I. General information

NPI: 1619342896
Provider Name (Legal Business Name): AMERICAN CAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72048 WOBURN CT
THOUSAND PALMS CA
92276-2319
US

IV. Provider business mailing address

72048 WOBURN CT
THOUSAND PALMS CA
92276-2319
US

V. Phone/Fax

Practice location:
  • Phone: 760-329-3002
  • Fax:
Mailing address:
  • Phone: 760-329-3002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: MR. GREGORY KLIBANOV
Title or Position: CEO
Credential:
Phone: 310-486-8000