=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770038655
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SULAY ENTERPRISES INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2016
-----------------------------------------------------
Last Update Date | 08/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7137 ADWEN ST
-----------------------------------------------------
City | DOWNEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90241-4153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-386-5981
-----------------------------------------------------
Fax | 562-928-8785
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7137 ADWEN ST
-----------------------------------------------------
City | DOWNEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90241-4153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-386-5981
-----------------------------------------------------
Fax | 562-928-8785
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | ALLISON SULAY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-386-5981
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | C3264153
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------