MEDICARE: LAVIDA

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	:	1861117285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAVIDA

Provider Business Mailing Address
First Line	:	6966 65TH ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-2355
Country	:	US
Telephone Number	:	916-435-4326
Fax Number	:

Provider Business Practice Location Address
First Line	:	6966 65TH ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-2355
Country	:	US
Telephone Number	:	916-435-4326
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHADIA NASRALLA
Credential	:
Telephone Number	:	916-435-4326

Provider Enumeration Date	:	10/07/2022
Last Update Date	:	11/10/2022

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Directions to “LAVIDA ” Practice Location

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