MEDICARE: FUN N GO NON MEDICAL TRANSPORT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)	C3829627	CA

General Provider Information

NPI Number	:	1174982516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUN N GO NON MEDICAL TRANSPORT

Provider Business Mailing Address
First Line	:	1900 CAMDEN AVE
Second Line	:	SUITE 201
City	:	SAN JOSE
State	:	CA
Zip	:	95124-2942
Country	:	US
Telephone Number	:	844-238-6646
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 CAMDEN AVE
Second Line	:	SUITE 201
City	:	SAN JOSE
State	:	CA
Zip	:	95124-2942
Country	:	US
Telephone Number	:	844-238-6646
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	MS. MARIA CURA DIMBLA
Credential	:
Telephone Number	:	408-656-8988

Provider Enumeration Date	:	02/13/2016
Last Update Date	:	05/10/2016

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Directions to “FUN N GO NON MEDICAL TRANSPORT ” Practice Location

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