Provider Demographics
NPI:1407365463
Name:DRIVING ANGELS OF SOUTHERN CALIFORNIA, LLC
Entity Type:Organization
Organization Name:DRIVING ANGELS OF SOUTHERN CALIFORNIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-619-9090
Mailing Address - Street 1:24122 HOLLYOAK APT H
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-6960
Mailing Address - Country:US
Mailing Address - Phone:949-619-9090
Mailing Address - Fax:
Practice Address - Street 1:24122 HOLLYOAK APT H
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-6960
Practice Address - Country:US
Practice Address - Phone:949-619-9090
Practice Address - Fax:714-767-4198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle