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General NPI Number Information
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NPI Number | 1457415382
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Entity Type | Organization
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Legal Business Name | SSJ MEDICAL TRANSPORT
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8262 SOUTHPORT DR
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92646-4441
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Country | US
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Telephone | 714-749-7961
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Fax | 714-969-5630
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Provider Business Mailing Address
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Address Line | 8262 SOUTHPORT DR
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92646-4441
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Country | US
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Telephone | 714-749-7961
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Fax | 714-969-5630
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Authorized Official
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Title or Position | OWNER
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Name | MRS. AIDA MARIA HIPOLITO
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Credential | RETIRED RN
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Telephone | 714-749-7961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | MTN01007F
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License Number State | CA
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