=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548153240
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENLIGHTENED TRANSPORT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2025
-----------------------------------------------------
Last Update Date | 05/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2110 E FLAMINGO RD
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89119-5190
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-289-9797
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2110 E FLAMINGO RD STE 100C
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89119-5191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-289-9797
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PART OWNER
-----------------------------------------------------
Name | SAINT DON NIEL BAUTISTA REYES
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 702-289-9797
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------