=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104105048
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIDZ FIRST TRANSIT,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2011
-----------------------------------------------------
Last Update Date | 08/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 DIANE CT 2063 MAIN STREET #416
-----------------------------------------------------
City | OAKLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94561-2786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-679-9066
-----------------------------------------------------
Fax | 925-281-9102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 DIANE CT 2063 MAIN STREET #416
-----------------------------------------------------
City | OAKLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94561-2786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-679-9066
-----------------------------------------------------
Fax | 925-281-9102
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DONNA MARIE LOCKWOOD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 925-679-9066
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347B00000X
-----------------------------------------------------
Taxonomy Name | Bus
-----------------------------------------------------
License Number | C5902121
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------