MEDICARE: CONEJO VALLEY TRANSIT, 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)		CA

General Provider Information

NPI Number	:	1982114559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONEJO VALLEY TRANSIT, LLC

Provider Business Mailing Address
First Line	:	22141 VENTURA BLVD
Second Line	:	SUITE 302
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-1672
Country	:	US
Telephone Number	:	818-880-8780
Fax Number	:	818-518-1332

Provider Business Practice Location Address
First Line	:	22141 VENTURA BLVD
Second Line	:	SUITE 302
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-1672
Country	:	US
Telephone Number	:	818-880-8780
Fax Number	:	818-518-1332

Authorized Official
Title or Position	:	OPERATIONS MANAGER /MEMBER
Name	:	CINDY KEMAKOLAM
Credential	:
Telephone Number	:	818-880-8780

Provider Enumeration Date	:	10/09/2017
Last Update Date	:	05/03/2021

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