Provider Demographics
NPI:1114703675
Name:WELLNESS TRANSPORTATION LLC
Entity Type:Organization
Organization Name:WELLNESS TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:MESERET
Authorized Official - Last Name:TIBEBU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:207-347-9805
Mailing Address - Street 1:1850 WHITLEY AVE APT 915
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-4795
Mailing Address - Country:US
Mailing Address - Phone:207-347-9805
Mailing Address - Fax:
Practice Address - Street 1:1850 WHITLEY AVE APT 915
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-4795
Practice Address - Country:US
Practice Address - Phone:207-347-9805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)