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General NPI Number Information
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NPI Number | 1922549476
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Entity Type | Organization
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Legal Business Name | AGILE CARE TRANSPORTATION
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Dates
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Enumeration Date | 03/16/2017
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Last Update Date | 03/12/2020
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Provider Practice Location Address
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Address Line | 6203 SAN IGNACIO AVE
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City | SAN JOSE
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State | CA
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Zip | 95119-1371
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Country | US
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Telephone | 510-512-5177
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Fax |
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Provider Business Mailing Address
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Address Line | 6203 SAN IGNACIO AVE STE 110
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City | SAN JOSE
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State | CA
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Zip | 95119-1358
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Country | US
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Telephone | 510-512-5177
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMEBER
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Name | AIMEN SULEIMAN
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Credential |
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Telephone | 510-512-5177
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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 |
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License Number State | CA
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