Provider Demographics
NPI:1114620895
Name:KEALSA TRANSPORTATION SERVICES
Entity Type:Organization
Organization Name:KEALSA TRANSPORTATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GILDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAIKHVAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-277-0864
Mailing Address - Street 1:PO BOX 501374
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92150-1374
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13772 FONTANELLE PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4741
Practice Address - Country:US
Practice Address - Phone:619-277-0864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)