MEDICARE: ABRAHAM CARE TRANSPORTATION LLC

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)

General Provider Information

NPI Number	:	1255033601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABRAHAM CARE TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	9820 MIRA LEE WAY APT 18114
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4733
Country	:	US
Telephone Number	:	619-919-2424
Fax Number	:

Provider Business Practice Location Address
First Line	:	9820 MIRA LEE WAY APT 18114
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4733
Country	:	US
Telephone Number	:	619-919-2424
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MAZEN ALI
Credential	:
Telephone Number	:	619-919-2424

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	03/20/2023

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