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General NPI Number Information
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NPI Number | 1023434610
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Entity Type | Organization
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Legal Business Name | DIVERSIFIED TRANSPORTATION ACCESS, LLC
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Dates
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Enumeration Date | 03/06/2014
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Last Update Date | 03/06/2014
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Provider Practice Location Address
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Address Line | 1255 MIDVALE AVE APT 506
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City | LOS ANGELES
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State | CA
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Zip | 90024-4876
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Country | US
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Telephone | 310-400-0260
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Fax |
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Provider Business Mailing Address
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Address Line | 1255 MIDVALE AVE APT 506
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City | LOS ANGELES
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State | CA
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Zip | 90024-4876
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. BEN BAREL
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Credential |
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Telephone | 310-435-0710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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