MEDICARE: REACH OUT 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)	MTN01237F	CA

General Provider Information

NPI Number	:	1588761274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REACH OUT TRANSPORTATION, LLC

Provider Business Mailing Address
First Line	:	1917 OTOOLE WAY
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95131-2238
Country	:	US
Telephone Number	:	408-954-8812
Fax Number	:	408-228-8712

Provider Business Practice Location Address
First Line	:	1917 OTOOLE WAY
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95131-2238
Country	:	US
Telephone Number	:	408-954-8812
Fax Number	:	408-228-8712

Authorized Official
Title or Position	:	OWNER/MEMBER
Name	:	RICHARD CRISTOBAL
Credential	:
Telephone Number	:	408-259-0689

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	10/22/2009

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