Healthcare Provider Details

I. General information

NPI: 1093671075
Provider Name (Legal Business Name): PRIDE FAMILY TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 LAGOON AVE
WILMINGTON CA
90744-5415
US

IV. Provider business mailing address

617 LAGOON AVE
WILMINGTON CA
90744-5415
US

V. Phone/Fax

Practice location:
  • Phone: 310-483-6905
  • Fax:
Mailing address:
  • Phone: 310-483-6905
  • 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: JOSE HERCTOR CUEVAS
Title or Position: MANAGER
Credential: OWNER
Phone: 310-483-6905