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General NPI Number Information
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NPI Number | 1821460148
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Entity Type | Organization
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Legal Business Name | GOLDEN VALLEY TRANSPORT
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Dates
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Enumeration Date | 10/26/2015
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Last Update Date | 10/26/2015
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Provider Practice Location Address
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Address Line | 305 CINNAMON TEAL WAY
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City | NEWMAN
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State | CA
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Zip | 95360-9543
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Country | US
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Telephone | 209-417-2742
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Fax |
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Provider Business Mailing Address
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Address Line | 305 CINNAMON TEAL WAY
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City | NEWMAN
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State | CA
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Zip | 95360-9543
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Country | US
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Telephone | 209-417-2742
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Fax |
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | MR. JOSHUA C JACOPETTI
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Credential |
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Telephone | 209-417-2742
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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 | D4485189
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License Number State | CA
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