MEDICARE: S & A LB 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	:	1316750078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S & A LB TRANSPORTATION, LLC

Provider Business Mailing Address
First Line	:	2521 E 7TH ST APT 4
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-4662
Country	:	US
Telephone Number	:	562-606-4934
Fax Number	:

Provider Business Practice Location Address
First Line	:	2521 E 7TH ST APT 4
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-4662
Country	:	US
Telephone Number	:	562-606-4934
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. AUGUSTO GONZALEZ
Credential	:
Telephone Number	:	562-606-4934

Provider Enumeration Date	:	01/28/2025
Last Update Date	:	01/28/2025

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