MEDICARE: RAIDEN RIDES

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	:	1841833530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAIDEN RIDES

Provider Business Mailing Address
First Line	:	2657 E WASHINGTON BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-1412
Country	:	US
Telephone Number	:	626-394-9571
Fax Number	:

Provider Business Practice Location Address
First Line	:	2657 E WASHINGTON BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-1412
Country	:	US
Telephone Number	:	626-394-9571
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LISA MCCLURE
Credential	:
Telephone Number	:	626-260-5710

Provider Enumeration Date	:	10/24/2019
Last Update Date	:	10/24/2019

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Directions to “RAIDEN RIDES ” Practice Location

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