MEDICARE: IDPELEKTIVZ

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	:	1730047903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDPELEKTIVZ

Provider Business Mailing Address
First Line	:	7950 ETIWANDA AVE APT 12208
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91739-8716
Country	:	US
Telephone Number	:	714-208-5804
Fax Number	:

Provider Business Practice Location Address
First Line	:	7950 ETIWANDA AVE APT 12208
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91739-8716
Country	:	US
Telephone Number	:	714-208-5804
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAY BENARD
Credential	:
Telephone Number	:	562-477-3217

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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Directions to “IDPELEKTIVZ ” Practice Location

Language	Start Address	Practice Location

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